Request for Traveling Workshops

  • Audience must contain 25 or more individuals or fee may be added.
    (if you have less than 25 please go to or
  • Please complete this form and click the submit button at the bottom
  • Form must be submitted approximately 3 to 4 weeks prior to the desired date
  • Complete one form per topic/target audience. For example, if you wish to have one workshop regarding Introduction for Brain Injury for staff and one regarding Brain Injury in Students, then complete a different form for each workshop

Requestor Information

Workshops *
Target Audience (check all that apply) *
0/255 characters
Prefered Date(s): List top 3 preferences for dates and time for the presentation *
 DateStart TimeEnd TimeTotal Time