EmailMe Form - Presentation Request Form

EmailMeForm

Which presentation are you requesting? *
NAMI Ending the Silence STUDENTS (50 min)
NAMI Ending the Silence TEACHERS (50 min)
NAMI Ending the Silence PARENTS (50 min)
NAMI In Our Own Voice (90 min)
Mental Health in the Workplace (90 min)
Mental Health 101 (60 min)
Provider Education Seminar (4 hours)
Family and Friends Seminar (4 hours)
OTHER
If OTHER - indicate which presentation you're requesting.
Name of Primary Contact *
First Last
Email for Primary Contact *
Phone for Primary Contact *
### - ### - ####
Preferred Dates - To expedite scheduling, please provide a variety of dates. *

First Choice

Second Choice

Third Choice

PLEASE NOTE * NAMI Central Florida programs are run by Trained Volunteers with lived experience. To allow for proper scheduling, please propose dates 30 days in advance. Thank you.
Preferred time (AM/PM) for presentation - *

First Choice

Second Choice

Please put specific numerical time slots!
Are you requesting more than one presentation at the same location? If yes, please provide the schedule for the day, and audience(s) present. *
Total time available for presentation *
Name of your Organization *
Website or brief description of your organizations work *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Will the presentation be held at the organization's address? *
Yes
No
Are there any parking instructions or building information (room number for example) or other information that would help the presenters find the presentation location? *
Is the presentation location ADA compliant? *
What is the age demographics for the audience? *
What is the expected size of the audience? *
What A/V equipment do you have available? *
DVD Player
TV (for DVD)
Computer (For PowerPoint or DVD)
Projector with Screen
Microphone
Other
Will this presentation to be open to the public? Note: Public presentations may be posted on our website, within newsletters, or other forms of promotion. *
Do you have additional comments or considerations for this presentation request?
Were you one of our incredible volunteers? Tell us about your experience!

First Choice
Second Choice
Third Choice

First Choice
Second Choice