Book A Presentation

YOUR INFORMATION

Name *

First

Last

Email *

Contact Phone Number

School Name(s) *

School District *

SPEAKER LOCATION AND DATE

Physical Address for Presentation - including room (ex. Auditorium) *

Address Line 1

Address Line 2

City

State

Zip Code

STUDENT PRESENTATION - 40-45 MINUTES (CHECK ALL THAT APPLY) *

Middle School Students (6-8) - 40-45 minutes
High School School Students (9-12) - 40-45 minutes
NOT Applicable

ADULT PRESENTATION 45-60 MINUTES (CHECK ALL THAT APPLY) *

Parents - 40-45 minutes
Educators - 40-45 minutes
NOT Applicable

Number of Attendees *

Date / Time (Option 1) *

Date

Time

Date / Time (Option 2) *

Date

Time

Reason for presentation request (this data helps us understand your presentation needs) *

Educational
Campus experiencing cyberbullying
Professional development (educators)

Does your campus currently have an anti-bullying program and/or club? *

Yes
No

What outcome(s) would you like to see after hearing the David's Legacy Foundation presentation? (check all that apply) *

Awareness and understanding of Cyberbullying
Awareness and understanding of David's Law
Change in behavior

Have you reviewed the David's Legacy Foundation Presentation Flyer? * Click Here to Review the Presentation Flyer

Yes
No

IS YOUR CAMPUS OR ORGANIZATION ABLE TO FULFILL THE FINANCIAL OBLIGATION FOR THIS PRESENTATION (PRESENTATION FEE AND TRAVEL COSTS)? * Click Here to Review the Presentation Flyer

Yes
No

BOOK A PRESENTATION

YOUR INFORMATION

SPEAKER LOCATION AND DATE