PHF Training/Speaker Request

Thank you for your interest in collaborating with our team! We use the information provided to tailor presentation content and provide an estimated cost for the session. All fees and honorariums go towards supporting our non-profit's mission, including facilitating free healthcare for GBV survivors and their children. We are sensitive to the budgetary constraints of non-profit and student events and can collaborate accordingly through a sliding scale. Thanks again, and please feel free to let us know if you have any questions: Training@PurpLEHealthFoundation.org
Sign in to Google to save your progress. Learn more
Name *
Email *
Organization Name *
How did you hear about PHF? *
Required
Conference Title (if applicable)
Training/Speaking Topic *
Presentation Date and Time *
Presentation Length *
Training Type *
Will training/presentation be recorded? (Please note, we typically opt out of recordings of trainings and workshops, but are happy to review requests on a case by case basis) *
Anticipated Number of Attendees *
Background(s) of Attendees (Ex: Physicians, NPs, Social Workers, Survivor Community Members, Residents, Students, Lawyers, Patient Advocates, etc.) *
Honorarium Amount (if applicable)
Any additional information to convey to our team
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of purplehealthfoundation.org. Report Abuse