You Drink & Drive. You Lose.

Application for Program Presentation

(please type or print clearly)

 

Name of school:

  

School address:

  

Name of school principal and phone number:

  

Name of Driver’s Education teacher and phone number:

  

Preferred date(s) for program to be presented:

  

Time for the program to take place:

  

Location in the school where the program will be held:

  

Number of students expected to be in attendance:

  

Could the school provide:

  1. A podium?
  2. A microphone?
  3. Parking for speakers?
  

Sponsoring organizations: Illinois Judges Association,

Illinois State Bar Association, Illinois State Board of Education.

Please complete and return to: Illinois Judges Association, 321 South Plymouth Court, Chicago, IL 60604 or illinoisjudge@ameritech.net