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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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Title
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Zip Code
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Email Address
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Group/Organization
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Phone
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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
Heads Up! Seniors: A Fall Prevention and Pedestrian Safety Program for Older Adults
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
Other Education and Prevention Programs
Concussion in Youth Sports
Concussion in the Classroom
Sports Injury Prevention for Youth
Brain Injury Prevention and Safety Overview
Home Safety Tips for Your Family
Summer/Water Safety
Medicine and Poison Prevention
Halloween Safety
Winter Holiday Safety
Advocacy
Target Audience
(check all that apply)
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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
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1-10
11-25
26-40+
Will this be held in-person or virtual?
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In Person
Virtual (ZOOM)
What are you looking to achieve with this workshop?
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Prefered Date(s): List top 3 preferences for dates and time for the presentation
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Date
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End Time
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Date
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Date
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End Time
Total Time
3
Date
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End Time
Total Time
Workshops can be customized! Please let us know if you have any additional needs regarding your requested workshop.