Presentation Request Form
Requested Presentation *
Requested Presentation Date *
We will contact you to confirm dates, times, etc.
Your answer
Start Time: *
Your answer
End Time: *
Your answer
Time Zone: *
Number of Participants: *
must be at least 10 in attendance
Your answer
Type of Audience: *
staff, youth, parents, etc
Your answer
Organization: *
Your answer
Address of Training Location: *
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City: *
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Zip: *
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County in Indiana: *
Your answer
Contact Person: *
Your answer
Email Address: *
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Phone Number: *
Your answer
Alternate Phone Number: *
Number to reach someone on the day of Presentation:
Your answer
Can you provide a Screen or White Board (wall)? *
Required
Can you provide a Computer / Projector with PowerPoint capabilities? *
Required
Directions to Training Location from our office (3833 N. Meridian Street, Indianapolis, IN 46208) *
Please to not direct us to MapQuest or other online map search (it is unreliable)
Your answer
If there are any time changes, cancellations etc., please notify Katherine King at kking.pcain@villages.org or call 317-775-6439 ASAP
Other Notes:
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