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youth infusion event registration form

By Margaret Griffin,2014-04-30 01:17
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youth infusion event registration form

    youth infusion event registration form

    please email completed form to sarah.schulman@stanford.edu

    Today’s Date: Organization Name Staff Contact Name

    Email Address Phone Fax

Date of Event Event Title Description of Event (Purpose, Goals, Other Speakers) Where Will the Event be Held? Event Logistics: Access to LCD Projector?

     Access to Sound System?

     Access to Photocopier?

Audience: Youth Adults Youth/Adults Expected Number: _______Youth ________ Adults

    Youth Audience’s

    Familiarity with Experts Received Previous Event Subject Training Limited Knowledge

    Matter: Completely New Subject

     Adults

     Experts Received Previous

     Training Limited Knowledge

     Completely New Subject

     Keynote General Session Type of

     Workshop/Breakout Retreat Presentation

    Requested: Meeting Facilitation Training

     Other ______________

    Presentation

    Audience: Youth Adults Youth/Adults

Expected Number: ________Youth ________ Adults

Presentation Length:

What are your goals for the presentation?

**If you would like Youth Infusion to conduct more than one presentation at your event, please fill out a separate form for each

    (excluding the general organizational information that you already completed)

    Program Materials (Do you need Youth Infusion to submit materials prior to the event?) Date Needed By: ______________________

     Presentation Description Speaker Bios Handouts

    Youth Infusion Materials (Would you like Youth Infusion to develop customized curriculums, handouts, etc.?) Date Needed By: __________________

     Pre-Conference Packets for Participants Conference Packets Brochures Website Content Curriculums Take Home PowerPoint Pre-Event Media Training (Would you like Youth Infusion to provide media training to staff/youth leaders prior to the event?)

     Yes No

Anything Else Youth Infusion Should Know?

    Youth Infusion provides its services to organizations free of charge, provided all travel expenses and supplies are taken care of by the organization. Youth Infusion typically sends two staff members to each event. Supply expenses are generally under $250.00

     Should we arrange transportation independently, and submit reimbursements?

    OR

     Should we arrange transportation through your organization?

Additional Reimbursement Procedures We Should Follow:

X

     SIGNATURE DATE

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