Request Us
* Required
Name:
*
Your answer
Name of your organization:
*
Your answer
Position title:
*
Your answer
Phone number:
*
Your answer
Secondary phone number:
*
Your answer
Email:
*
Your answer
Date of presentation/event requested:
*
MM
/
DD
/
YYYY
Time of presentation/event requested:
*
Time
:
AM
PM
Presentation topic requested:
*
Choose
Overview of Atlantic Wellness - Our Impact
Brilliance of the Teenage Brain
Boundaries & Social Media
Growth Mindset
Sleep
Objectives of the presentation:
*
Your answer
Address of presentation site:
*
Your answer
City:
*
Your answer
Please describe the presentation space and resources available to our presentor (auditorium, classroom, meeting room, will we have a mic). NOTE: Depending on the topic, presenter may have specific preferences for group size and room set up to ensure proper delivery:
*
Your answer
Description of event or presentation (ie. tour, group, presentation, booth, workshop, panel)
*
Your answer
Anticipated audience (demographic and size):
*
Your answer
Anticipated duration of presentation:
*
Your answer
Other comments:
*
Your answer
Submit
Never submit passwords through Google Forms.
Forms
This form was created inside of Atlantic Wellness Community Center.
Report Abuse
Terms of Service
Privacy Policy