Panel Request Form
Please fill out the following fields to make your panel request. Fields with an * are required. Provide as much detail as possible. Thank you.
Email address
Instructor's name
Your answer
Email Address of Main Contact Person
Your answer
Phone Number
Your answer
Panel Location: Address, Building Name/#, Room #, etc.
Your answer
If a class, what is the class title?
Your answer
What is the approximate audience size?
Your answer
Please give two day and time slots (1st & 2nd) and we will do our best to accommodate your request.
Your answer
How long is the allotted time period for the panel?
Your answer
What panel(s) are you requesting?
Required
Is there parking available nearby?
We request that parking passes be made available to our presenters.
If the presenters should bring cash, how much is a parking pass at your location?
Your answer
Please include links to the campus and parking maps.
Your answer
We do request an honorarium of $150 per presentation per semester. No one is turned away for lack of funds, but in this case we ask that you fill out a fee waiver form. *If scheduling 3 or more presentations in a semester, we ask for $150 for the first and $300 for three presentations. (Buy two, get one FREE!) Please read this post for more information: http://positivesexuality.org/new-pricing-structure-for-education-panels/
What is the technology like in the space?
Required
Comments: Is there more information we should know? Do you have any unanswered questions?
Your answer
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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