Host A Speaker
Name
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First Name
Last Name
Name of group or organization
Email
*
example@example.com
Phone Number
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-
Area Code
Phone Number
Date and time you are requesting a presentation.
*
Alternate date and time.
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Location of Presentation
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of Participants
*
Describe targeted audience
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Please select any equipment you have available to the presenter
Computer
Projector
Microphone
Audio equipment
Presentation to be presented
*
RCC Overview
Domestic Violence 101
Sexual Assault 101
Healthy Relationships
Relationships; The Good, The Bad, & The Abusive
Recognizing the Signs
Teen Dating Violence
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