Brain On Tour Request Form

BRAIN ON TOUR REQUEST
Brain on Tour is a 45 minute presentation given by Dr. John Burnside targeting children in grades 3-5. It consists of a few minutes of Neuro Anatomy, fun facts about the brain, and demonstrations with volunteers about how doctors check brains in our offices. The idea is to teach kids how special their brains are and to encourage them to protect their brains. It is a little like Bill Nye the Science Guy, meets Robin Williams. It is informative and fun for students and teachers alike.
Requester's Name*

First NameLast Name
E-mail*
Details
Date Requested*

MonthDayYear
Date & Time of the Requested Presentation*

MonthDayYearHourMinutesAM/PM Option
Address Of School*
Audience Age and Number Expected*
Special Requests
Type a question
Should be Empty:

BRAIN ON TOUR REQUEST