Request form for Speakers, Presentations, Training

Request form for Speakers, Presentations,Training
Thank you for you interest in education from NAMI Southeast Minnesota!

Please fill out the form below and we will reach out to you shortly.

PLEASE NOTE: We require requests to be submitted at least 10 business days before the proposed training or presentation. We cannot guarantee acceptance of any requests submitted with less than 10 business days notice.
Name of organization/school *
Address of the orgnanization*

Street Address

Street Address Line 2

CityState

Zip Code
Contact Person Name *
Email*
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
EmailPhone
Event*
Event purpose*
Address of Event*

Street Address

Street Address Line 2

CityState

Zip Code
Date of Event*

MonthDayYear
Date
Time*

Hour Minutes

AM/PM Option
In personOnline
ReoccurringOne time
30 minutes45 minutes1 hourOther
Who is the primary audience
Est. Attendance*
Do you have audio visual technology for presentations, please describe it
Other information you feel would be important for us to know
ABOUT THE PROPOPSED TRAINING/PRESENTATON
Understanding NAMINAMI Ending the SilenceNAMI In Our Own VoiceCommunication & Self-careNAMI StigmaFree WorkplaceA Personal Recovery StoryCustomized Education
If you selected "customized education", please tell us about your goals and learning objectives.
OTHER NEEDS
Any Language Requirements? (e.g. Spanish speakers, Limited English Proficency)
Any Culturally-Specific Approaches Required?
Any Accessibility Requirement? (e.g. ASL interpreters, braille materials,quiet spaces)
Any other comments?
HONORARIUM
*Honorariums help support and expand NAMI education programs. Donations ensure presenters are well-trained and that education programs are available to everyone, regardless of ability to pay. If you are unable to pay the honorarium, please enter "0"and we will work with you to provide the same quality programming at no cost.
$1,000$750$500$250Other
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Request form for Speakers, Presentations,Training