Advocacy Self-Defense® Bootcamp Request Form
Book this bootcamp to equip your clients, communities, or church members with the skills to advocate for themselves, navigate systems, and stand firm.
Organization Name
*
Point of Contact
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization Website
*
Bootcamp Format (choose one)
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4-week series (2 hours each session)
1-day intensive (8-hour day)
Delivery Preference (choose one)
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In-person
Virtual
Preferred Dates / Timeframe
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Expected Number of Participants
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Who Will Be Attending? (check all that apply)
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Community members/clients
Youth/young adults
Faith-based groups/churches
Other
Payment/Funding Method (choose one)
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Covered under program funding
Direct pay arrangement
Specific Grant Line Item (you want to write this into a grant)
Additional Notes or Special Requests
*
Acknowledgement
*
I understand that submitting this request does not guarantee scheduling. Advocacy Queen® will follow up to confirm availability and details.
Submit
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