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Training, Workshop & Speaker Requests
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Email *
Contact Name & Title *
Pronouns (Check all/any that apply)
Phone Number
Organization/Business *
Type of Organization/Business *
Required
Please choose the nature of the request *
Required
Event Address (If online, indicate platform- Zoom, GoToMeeting, etc ) *
Organization/Business Address (if different from Event Address)
Event Date(s) If unknown TBD *
Time(s) (Include special directions i.e. multiple workshops) If unknown, enter TBD *
Anticipated Number of Participants *
Describe Participants (For staff, please include educational attainment and professional positions and populations served. For all others, please include age, ethnicity, and other socio-demographic descriptives.)
Reason for Request (Include any relevant events leading up to Request)
How did you hear about Left Turn Village? (Include names of anyone who referred you)
Which workshop topics are you requesting? *
Required
Please provide at least two (2) learning objectives you have for participants
If you have been quoted a fee, please enter it here. If not, please enter TBD. *
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