KLIK 2016-2017 SPEAKER’S CONFIRMATION

FORM
Please EMAIL this form to claforteza@ateneo.edu OR to your contact on or before 14 JANUARY 2017
(FRIDAY)

FULL NAME: NICKNAME:

OCCUPATION/POSITION:

BUSINESS ADDRESS:

CONTACT NUMBERS: EMAIL:

NAME OF FACULTY CONTACT: ____________________________________________________________

To the Ateneo de Manila Senior High School Grade 12 KLIK Committee:

Yes, I would be glad to handle (please check the appropriate box)

ONE KLIK session at the following time slot:

9:15 – 10:30 11:05 – 12:20

TWO KLIK sessions at both time slots above.

Kindly provide us with the following information that will be the basis of a write-up we will compose for
your session or class. All the class write-ups will be included in the KLIK Primer that will be given to the
students.

MODULE TOPIC/TITLE
I. Brief outline of the module or description of what participants can expect from the class

II. Any requirements from participants? (e.g. materials to be brought, proper attire, etc .)

III. Any equipment needed? Please check:

OHP LCD Projector Karaoke Others

Computer DVD player CD Player

IV. Any venue requirements, instructional materials needed or other requests?

V. Kindly indicate below some relevant information that will help us introduce you properly or please
attach a copy of your resume/curriculum vitae.

DATE SIGNATURE