Please complete this form for any program requests at least two weeks in advance.

Describe what you hope your participants will gain from attending this program. Please be specific.
Please indicate what type of presentation you would like
Please list 2-3 date options, with your preferred date listed first.
Please list 2-3 time options (ex: 6 PM - 7 PM, 3 PM - 4:30 PM, etc.)
Are you planning any other activities during the presentation? Is there any additional information you feel is relevant?