School or Group:____________________________________________________

Contact Person:_____________________________________________________

Address:__________________________________________________________

____________________________________________________________

____________________________________________________________

Phone Number:_____________________________________________________

Visit Date:_________________________________________________________

Time:_____________________________________________________________

Print Name and Title:________________________________________________

_________________________________________________

_________________________________________________

Authorized Signature:________________________________________________

Date:_____________________________________________________________

Please enclose a map illustrating your facility locations and an area where CAPOW! can unload and park. Also, please print the name of the person to contact upon arrival.

Reminder: Two 5-foot tables need to be set up before CAPOW! arrives. CAPOW!
Demonstrations require one hour of set up time.