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Parents Reaching Out to Parents


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Request for a Workshop or Presentation


Required Field(s) are Indicated with a * (in Red)

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* Who is this workshop being planned for: (Please check all that apply)  

Workshop Dates Requested (Please list at least three potential dates, if your dates are flexible):

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Workshop Time(s) Requested:

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* Duration of Workshop:  

   

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Emergency Contact for Host Organization at time of Workshop (Name and Phone Number):

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* Please insure that the facility is handicap accessible.

If you cannot or do not want to submit the completed form online, please print the completed form and fax the information to (803) 772-5341


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