The Orkin Man Presentation

When properly introduced, insects can be a great way to spark your students’ interest in science. Equipped with scientific knowledge on insects of every kind and educational materials to supplement your science lessons, Orkin can help you add fun and excitement to this year’s science curriculum. Please complete the following form if you’re interested in receiving a visit from your local Orkin Man.

	Please complete the following:
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	Teacher's Name:	School Name:
	*	*

	School Address:	City:
	*	*

	State:	Zip:
	*	*

	Daytime Telephone Number:	E-mail Address:
	*	*



	Grade Level for Presentation: (The Orkin Man School Presentation is designed for grades K-6.)	Number of Students for Presentation:
	*	*

	Requested Presentation Date & Time: (Please allow 2-3 weeks for scheduling of presentation)

	First Choice:
	*

	Second Choice:
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	Are you a member of the National Science Teachers Association (NSTA)?
	Yes No

	How did you hear about the Orkin Man presentations?
	*

	Please indicate which insects you would like to see featured on future posters:
	*

	Note/Special Request: