Career Ambassador Request Form

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Name*

First Last

Email address*

Telephone number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

School/Organization Name*

Position Title*

Description of youth audience/grade level(s):*

Size of group:

Description and objectives of speaking engagement:*

Date(s) and time of speaking engagement:*

Location of Event

In person (provide address):

Virtual presentation (provide platform):

Do you have any additional information you would like to share:

*Information provided by applicants will be kept confidential and will only be used by the Mining Industry Human Resources Council (MiHR) and the Canadian Institute of Mining, Metallurgy and Petroleum (CIM) to administer the We Need Mining. Mining Needs You. Career Ambassador Program.