Mass Incarceration Presentation Interest Form
Thank you for your interest in learning more about mass incarceration in our region through the Clark-Fox Family Foundation's presentation. We ask you to fill out this form with your ideal date, time, location, and other information so we can better plan for our experts to present to your organization. Please complete all details to the best of your ability. We will send you a copy of your responses for your records.
Organization Name:
*
Name of Contact Person to coordinate details and technology:
*
First Name
Last Name
Contact Person Email:
*
example@example.com
Contact Person Phone Number:
Please enter a valid phone number.
Our ideal presentation duration is 90 minutes. Does this duration work for your organization? If not, please let us know by checking "No, our time limit is:" and filling in the provided response box so we may alter our presentation accordingly.
*
Yes
No, our time limit is:
Do you have an ideal date in mind?
*
Yes
No
Ideal Date of Presentation:
*
-
Month
-
Day
Year
Date
Ideal Time of Presentation:
*
Time
Second Option for Date of Presentation
*
-
Month
-
Day
Year
Date
Second Option for Time of Presentation:
*
Time
If you do not have a specific date or time in mind, is there a range of dates or times that may work for you? Please list any upcoming availability your organization has during which we could give our presentation.
*
Ex: Organization meeting first Tuesday of Every Month 11:00-1:00
Location of Presentation:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For the presentation, we need either a projector or screen for a PowerPoint and the ability to share audio for two short video clips. What technology is available for our use at this location?
*
Approximately how many people will be in attendance for the presentation?
*
Ex: 25-35
Any additional comments or requests?
Submit
Should be Empty: