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Prevention Presentation Request Form
Contact Information
Who should we contact about this presentation?
Name
*
First Name
Last Name
Organization/Agency
*
Email
*
Verify Email
*
Phone
*
Alternative Phone
Presentation Information
What kind of presentation are you looking for?
Intended Purpose of Training
Why would you like to hold a DV presentation? What would you or your organization like to get out of the training?
Requested Date
*
(mm/dd/yyyy)
Alternative Date
(mm/dd/yyyy)
Presentation Timelength
*
How much have you allocated for this presentation? Please note that our Introduction to Domestic Violence Training has a 90 minute minimum.
Audience Information
Who will be receiving this presentation?
Number of Attendees
*
Type of Audience
*
Please give us a little information about who will be attending. Things like age range, grade, profession, or specialization are all helpful.
Attitude/Motivation of Audience
*
Is the audience mandated to be there or is it voluntary? Do they have prior experience or information about this topic?
Location Information
Where will the presentation be held?
Will the presentation be held virtually, or in-person?
*
If the presentation is virtual, please give us the details over the phone or via email.
select one
Virtually
In-person
Name of Venue
Address of Venue
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
AV Equipment Available?
Is there any equipment for the presentation already available? This may include laptops, LCD projectors, laptop cords, projection screens, dry erase boards, etc.
Room Name/Number
Parking Availability?
select one
Yes
No
Parking Permit Needed?
select one
Yes
No
Other Information
Anything else we should know?
Other Comments?