Name*

Email Address *

Phone Number*

Name of Class, Department or Organization requesting a presentation*

Preferred Date*

Preferred Time*

How long should the presentation last?*

In-person or Virtual?*

If in person, please provide location*

Estimated number of participants*

Other ( If you have a different workshop topic not listed, please provide additional information.)*

Please describe the audience and goals for your requested presentation and provide any additional context that would help us tailor the session to your group.*