Adult Outreach Speakers & Programs Request Form

Name of your Organization or Group

Name of Primary Contact

First

Last

Primary Contact’s Title/Affiliation with Group

Email

Phone

Type of Outreach Event

In-person Program at NBG

In-person Program at your location

Virtual Presentation

Undecided

Please provide the address of the programming location if other than NBG

1st Choice: Preferred Date/Time for Program

2nd Choice: Preferred Date/Time for Program

Estimated Number of Attendees

Please provide a brief description of your event and/or the type of programming you are interested in.

Your Booking Deadline (Note: it can take up to 14 days to complete the booking process. Please be sure to plan in advance with your deadline in mind.)

How did you hear about our outreach programming?

NBG Website

Recommended by community member

Attended one in the past

OtherOther

If there is a staff member you are particularly interested in or anything else you’d like us to know please indicate it here.

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