Paul Young, MD
For more information or questions please reach out with Sue Wilson at swilson@liftingupstl.org
Brain Awareness Talk
Middle School, High School, Educators, Coaches, Parents
School Name:
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Teacher E-mail
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example@example.com
Teacher Mobile Number
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Level of Programming You Are Interested In
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Middle School
High School
Mix of Middle School and High School
Educators/Parents/Coaches
Other
Location at the school where the program would take place:
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Time of Day You Would Like
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AM
PM
Preferred time if possible:
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Date Preference #1
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Month
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Day
Year
Date
Date Preference #2
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-
Month
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Day
Year
Date
Date Preference #3
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Month
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Day
Year
Date
Please note any additional information on the AV/sound set up and what would be available for Dr. Young to use during his presentation.
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Submit
Should be Empty: