South Shore Regional School Board 
Information Form 
RCH Facilitator Information 

*Please complete the information below and return,
by fax to: Lamar Eason, RCH Coordinator, (902) 541-3049
Group/Individual/Company Presenting		
Mailing Address	
	
Date of Presentation		
Title of Presentation		
Brief Outline/Description of Presentation	

	

AV Equipment Required: _________________________________________________________

Special Room Requirements: _____________________________________________________

Materials Required: _____________________________________________________________

Maximum Capacity/Session: _________________

Other Details: _________________________________________________________________

Payment Details

*Note: for accounting purposes the South Shore Regional School Board will require a mailing address and social insurance number (SIN).

Cost of facilitation: ______________________ 

Mileage included: _____ Yes   _____ No

For SSRSB Office Use	

GL: _____________________
CC: _____________________
	
Accommodation Required: _____ Yes   _____ No   

Substitute Needed: _____ Yes   _____ No   

 SIN: ___________________