Request for Presentation or Talk
Would you like to host a talk or training at your civic club, place of worship, care community, or somewhere else? Please tell us more.
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Email *
What is your name? *
What is your phone number?  *
What is the best way to reach you?  *
Required
If you are not the primary contact for this talk, who is and what is their contact information? 
What is the name of your organization or group? *
What type of organization or group is this?  *
Required
What type of audience *
If you are a professional group? Do you want Adult Care Home level continuing education through the NC Dept of Health Service Regulation? 
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Where are you located? (NC City & County) *
What type of talk would you like? *
When? Do you have a preferred day of the week or time of day? Are your dates and times fixed or flexible?
*Please note we are usually scheduling at least 2-3 months out. 
 *
How long would you like this session to be?  *
Do you have a particular topic in mind?  *
Are you requesting a particular speaker? 
What else would you like to tell us about the presentation you would like? 
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