Trainings and Presentations Information Form - Erickson Counseling Services, Inc.

Training and Presentation Information

Name of the person filling out this form. *

Title of person filling out this form

Name of Agency, Non-Profit or Corporation

Phone Number

Email

Additional Contact Person

Additional Contact Person Phone Number

Sponsoring Organization

Is applicant an incorporated not-for-profit organization? Yes
No

Event Where Training or Presentation Will Take Place

Not Sure Of the Date of Your Training or Presentation?

That's OK. Fill in the boxes below if you know the information or this can be discussed when we call you back to talk about options.

Event Name

Event Date(s)

Event Time(s)

General description of the planned event

Is the event open to the general public? Yes
No

If yes, will spectator fees be charged? Yes
No

Will the event be advertised to the general public? Yes
No

If yes, how and when

If other, please specify