PRESENTATION and OUTREACH REQUEST FORM

PRESENTATION and OUTREACH REQUEST FORM

Thank you for your interest in partnering with Verity. We’re always excited to connect with the community through education and prevention initiatives. To request a presentation or tabling event, please complete the form below. We kindly ask that outreach requests be submitted at least two weeks in advance.
Contact Information
Name of Organization/School
Contact Person

Full NameTitle/Role
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Event/Organization Details
Select Type of Request
Presentation Details
Preferred Date:

MonthDayYear
Date
Preferred Time

Hour Minutes

AM/PM Option
Location:
Location details (e.g., address, building, room number, parking instructions, etc.)
Presentation Format:
If in-person: Will a laptop and projector be provided?
If not, what device or setup do you have available for us to present from our laptop: HDMI, AirPlay, etc?
Audience Information:
The audience for this presentation will be (select all that apply):

Other
If youth:
Age/grade level:
How many attendees are expected?
Language preferred for presentation?
Note: Presentations are offered in either English or Spanish, not both, to ensure we can focus fully on delivering meaningful content within the allotted time.
Do you have a budget for this/these presentations?
What would you like your audience to get out of a Verity presentation?
Tabling Outreach Details
Name of the Event
Event Details:
Date of Event

MonthDayYear
Date
Time of the Event
Set-up Time
Breakdown Time
Venue Information:
Venue Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Will table and chairs be provided?
Audience Information:
What is the occasion/event for tabling?
Who is the expected audience?
(e.g., age group, students, families, Spanish speaking community)
Expected number of attendees?
Additional Information:
Is there anything else we should be aware of, such as special considerations or other important details?
Should be Empty:

PRESENTATION and OUTREACH REQUEST FORM

Contact Information

Event/Organization Details

Presentation Details

Audience Information:

Tabling Outreach Details

Event Details:

Venue Information:

Audience Information: