You must have JavaScript enabled to use this form. Please Note: The presentation/workshop fee will be provided in your follow up correspondance. PRESENTATION REQUEST DETAILS Date of Request Where did you hear about the Prevention and Wellness Centre? CONTACT DETAILS Contact Name Contact Name Company/Organization Name Company/Organization Name Type of Organization - Select -Not-For-ProfitFor ProfitCommunity Group Purpose of Event Describe the purpose of your event i.e fundraiser, campaign, employee wellness etc... Who is the sponsor of your event? (If no sponsor, please write "N/A".) Phone Email EVENT DETAILS Presentation Length (hours) Event Date & Time Event Date & Time: Date Event Date & Time: Time Event Location Audience Size (Minimum 20 people) Presentation Requested - Select -Know, Understand, ActRisk-Factor SpecificKnow, Understand, Act + Brief Risk Factor AssessmentNot Just an IncidentMedication ManagementBasic Cardiovascular Risk Assessment Leave this field blank
