Mercer Free School Activity Proposal Form

This form is to propose a new activity which you are willing to facilitate. Please fill in and submit it or e-mail a separate document with the same information.

This section is for the school to contact you.
Your name:
Your e-mail:

This section is for activity listing. [If you are not decided on certain sections, please leave them blank.]
Activity title:
Activity type: Lecture, Workshop, Group activity, On-line,
Activity date/time:
Activity location:
Facilitator name(s):
Registration: (please choose and enter whichever you would like to use)
  Through the school's on-line registration form & the school's phone (recommended)
  Through your own e-mail:
  Through school e-mail:
Your phone: (e.g., if you have a business number)
Activity web page: (if any, or a link to a relevant image)
Activity description:
Please type the following number 9626 in the box at right:
  [Submit button disabled]