Duty Trumps Doubt Event Application

Organization Name*
Contact Name*

First NameLast Name
Contact Email*
example@example.com
Contact Phone *

Area CodePhone Number
Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Name
Venue Name
If different than organization.
Venue Address (If different than organization.)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Date

MonthDayYear
Date
Event Time

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Time of JDNM Presentation

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Please indicate alternative date & time if applicable.
How did you hear about us?*

Company/SponsorEnewsletterFlyerFriend/FamilyPrint MediaRadioSocial MediaVoice2Change PodcastWebsiteOther
Name of friend/family member*

First NameLast Name
Name of company/sponsor*
What is your budget for this presentation?*
Audience*
Law Enforcement, Medical Personnel, Legal Professionals
Estimated # of Attendees*
Would you like a Q&A session?*

YesNo
May we hand out JDNM material?*

YesNo
Will you supply A/V equipment (microphone, speakers, projector & screen)?*

YesNo
Feel free to leave any other additional information or questions.
Our Duty Trumps Doubt program relies on funding from individuals, organizations, and businesses. We are happy to work with you to bring this program to your community.

Thank you for your interest.
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