Request Us
Please provide at least 1 month notice for a presentation request, you can request sooner but the likelihood of having someone available is low.
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Name: *
Name of your organization: *
Position title: *
Phone number: *
Secondary phone number: *
Email: *
Date of presentation/event requested: *
Time of presentation/event requested: *
Presentation topic requested: *
Objectives of the presentation: *
Address of presentation site: *
City: *
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: *
Description of event or presentation (ie. tour, group, presentation, booth, workshop, panel) *
Anticipated audience (demographic and size): *
Anticipated duration of presentation: *
Other comments: *
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This form was created inside of Atlantic Wellness Community Center.