Presenter Request Form

start
 
What date is desired? *

The orientation takes approximately 1 hour.
 
What time is desired? *

The orientation takes approximately 1 hour.

 
Approximately how many participants are expected? *


 
Does your facility have audio and video capability? *

     
 
If you answered "Yes" to question 4, what equipment is available? Please select all that apply.

If you answered "No" to question 4, please skip to question 6.

 
Please enter the name of your school/orgainzation: *

 
Please enter your First Name: *

 
Please enter your Last Name: *

 
Please enter the address: *

 
Please enter the City, State & Zip: *

 
Please enter your phone number(s) including area code: *

 
Questions?

Please feel free to contact Joseph Bianca at the following:

jbianca2@bellarmine.edu
or
502-272-8707

 
Thank you for submitting a request. We will contact you soon to make arrangements and finalize details.

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