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Someplace Safe Education Request Form
What is the name and contact information for the Individual or Organization making the request? *
Please share your NAME / ORGANIZATION / PHONE # / ADDRESS / EMAIL ADDRESS
Your answer
Who is the audience for this request? *
Required
Would you like information from a specific Someplace Safe program? *
What topic(s) would you like covered? *
Required
How many attendees do you anticipate? *
When would you like this Presentation to take place? *
Request must be made AT LEAST 2 weeks ahead of time whenever possible
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How long would you like this Presentation to be? *
Where would this Presentation take place? *
Please share the specific LOCATION and ADDRESS, including city, state and zip code.
Your answer
Are you able to provide any financial contribution in exchange for this Presentation?
Someplace Safe is a nonprofit providing services to victims and survivors of crime free of charge. We ask that you provide a small contribution if you are able to do so.
If YES, where should the invoice be sent?
Party responsible for the payment - Please include FULL NAME & ADDRESS information
Your answer
Are you able to provide any in-kind donation(s) or contribution in exchange for this Presentation?
Someplace Safe provides needed items for victims and survivors of crime in emergency situations.
Please note any additional questions, special requests, or information here.
Your answer
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