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Request a Speaker or Workshop
To request a workshop please fill in the information below
First Name
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Last Name
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Title
Street Address
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Town
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Zip Code
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County
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Email Address
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Group/Organization
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Phone
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Brain Injury Education
Introduction to Brain Injury
Adjustment to Brain Injury
Brain Injury in Students
Brain Injury & Substance Abuse
Brain Injury & Domestic Violence
Brain Injury & Mental Health
Return to Work After Brain Injury
Transportation Safety Workshops
Helmet & Wheeled Sport Safety
Distracted Driving
Pedestrian Safety
Teen Safe Driving
Child Passenger Safety
School Bus/School Zone Safety
Distracted Driving for Bus Drivers
Other Education and Prevention Programs
Heads Up! Seniors: A Falls Prevention Program
Concussion in Youth Sports
Concussion in the Classroom
Sports Injury Prevention for Youth
Brain Injury Prevention and Safety Overview
Advocacy
Target Audience
(check all that apply)
*
Professionals in the field of Brain Injury
School Professionals
Professional (not brain injury specific)
People with Brain Injury
Family Members
Elementary School Students
Middle School Students
High School Students
Older Adults
Other
Other
Estimated Number of Attendees
*
1-20
21-35
35+
Please
contact us
directly if in-person attendance is less than 20. Additional fee may apply.
Will this be held in-person or virtual?
*
In Person ($75 suggested donation)
Virtual (no attendee minimum)
What are you looking to achieve with this workshop?
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Preferred Date(s): List top 3 preferences for dates and time for the presentation
Date
Start Time
End Time
Total Time
1
Date
Start Time
End Time
Total Time
2
Date
Start Time
End Time
Total Time
3
Date
Start Time
End Time
Total Time
Workshops can be customized! Please let us know if you have any additional needs regarding your requested workshop.
BIANJ staff will reach out within 2 business days to schedule and send link for donation.