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Training, Workshop & Speaker Requests
Email address *
Contact Name & Title *
Pronouns (Check all/any that apply)
Phone Number
Organization/Business *
Type of Organization/Business *
Please choose the nature of the request *
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?
Which workshop topics are you requesting? *
Please provide at least two (2) learning objectives you have for participants
If you have not been quoted a fee, please enter TBD and you will be contacted to discuss price *
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