Community Outreach Request

Community Outreach

Please fill out the form below and press "submit" when complete.
What are you looking for MMC to provide? *

Outreach Booth Short Presentation (less than 20 minutes) Long Presentation (20 minutes or more) Panel Discussion Brochures only Other option
Submitted By *
Date
Event Date *

- Month - Day Year
Event Time *

: Hour Minutes
until
: Hour Minutes
Organization *
Event/Presentation Name *
Location *
Address *

Address *

Event Contact Person *
Title
Phone *
Email *
Details about the Audience *
Expected # of Attendees *
Languages *

English Spanish Other option
Length of Presentation *
Theme of Presentation *

Get to Know the Marjaree Mason Center DV 101 - How to Identify Domestic Violence Healthy Relationships Domestic Violence Effects on Children Human Trafficking Teen Dating Violence
Will you have a computer, recent version of PowerPoint program, projector, clicker, and sound capabilities for this presentation?

Yes No Other option
Brochures Requested *

DV 101 One Sheet, English/Spanish Legal Services Brochure, English Counseling Services Brochure, English Safe Housing Services Brochure, English Education Services, English Wish List, English Latest Printed Newsletter, English
Amount of Brochures Requested
Please choose a date you would like your request fulfilled by. (Allow a minimum of 3 business days) *

- Month - Day Year
Will a table, two chairs, and canopy be provided? *

Yes No Other option
Other Comments
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