Presentation Request Form

Presentation Request Form

Please complete this form for each presentation you are requesting. We ask that requests be submitted a minimum of three weeks in advance of the proposed presentation. If you are requesting is less than three weeks away, CCCNH cannot guarantee that we can accommodate your request.
Contact Information
Name

First NameLast Name
Organization
Phone Number
Please enter a valid phone number.
Email
example@example.com
Preferred form on contact
Presentation Details
Club/Organization Name
Date Requested - First Choice

MonthDayYear
Date
Date Requested - Second Choice

MonthDayYear
Date
Location or Virtual Location if remote (Zoom, Teams, Etc):
Length of time including questions (30 min minimum)
Start Time
Expected number of participants
Audience composition
Workshop topic requested: (CCCNH offers tailored presentations to suit your needs. Please indicate if you need help creating a presentation for your agency/group.)
List the technology available at the location: (Please indicate any specific technology needs/requests you may have).
Are there any other details we should be aware of?
Completing and submitting this request form does not guarantee your presentation is booked. A CCCNH outreach team member will contact you to confirm your request has been granted.
Should be Empty:

Contact Information