Request for Leadership Services

Request for Leadership Services
Council or Out-of-Council President*
Council or Out-of-Council PTA*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
District Officer(s)/Chair Requested*
Field Service Topic Requested*
Time Allotted*
Handouts Needed*
Yes/No
Date Confirmed with Participant*
Yes/No
Services Requested: Check All that Apply*

WorkshopBoard TrainingCouncil/Unit AssistanceGuest Speaker
Meeting Information
Date*

MonthDayYear
Date
Time to Start*

Hour Minutes

AM/PM Option
Time to End*

Hour Minutes

AM/PM Option
Name of Meeting Venue*
Room Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Program Topic:*
Anticipated Number in Attendence*
Audience will be composed of representation from: Check All that Apply*

UnitsCouncilTeachersAdministratorsStudentsCommunityOther
This event will be publicized by: Check All that Apply*

FliersCouncil/Unit NewslettersE-mail BlastsWebsite
The room will be equipped with the following: Check All that Apply*

Table with microphonePodium with microphoneFloor microphoneLCD projectorComputerScreen
Should be Empty:

Meeting Information