Presentation Request Form
Please fill in the following information to request a presentation or activity from the Recovery Resource Council.

If your organization/school would like to request multiple presentations or activities with different modalities (virtual vs in-person), you may complete the form multiple times.

When possible please allow a minimum notice of two weeks prior to the date requesting to better help us meet your need.

If you have any trouble with this form please email: v.moreno@recoverycouncil.org OR d.futrell@recoverycouncil.org

Thank you, we look forward to serving you! 😊
Name *
Title *
Email *
Phone Number (preferably cell) *
Organization or School Name *
Organization or School Address *
What county is your organization/school in? *
Required
Activity *
Would you prefer your activity be in-person or virtual? *
If your organization/school would like to request multiple presentations or activities with different modalities (virtual vs in-person), you may complete the form multiple times.
Presentation Topic
If this is for a presentation request, please select ALL that apply.
If this is for a Resource or Health Fair, please check ALL that apply:
For In-Person events.
If this is for a presentation, assembly or other activity, please indicate what technology accommodations you can provide.
For In-Person events. This is for our planning purposes only. Our Prevention Specialists need to know whether to bring a laptop or just their USB drive with their presentation. Please select ALL that apply.
Date(s) requesting *
If you do not have a specific date, please provide the best day of the week. Please keep in mind Red Ribbon Week dates are October 19th - October 23rd. (EX: Monday's OR September 18th)
Time *
If you do not have a specific time please provide the best time of day. Also include how long the presentation/activity will be. (EX: 12PM, 45 minutes OR 1PM, 30 minutes)
Audience *
Please select ALL that apply.
Required
How many audience members are expected to attend? *
This is for our planning purposes only.
If this activity is for students, please indicate which grade(s) below.
If this activity is for Faculty/Staff please indicate if they need Continuing Education for any of the following: *
Please select ALL that apply.
Required
Additional Information
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