Request Workshop

Contact

Organization Name

Contact Name

Contact Email

Contact Phone

Your Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Workshop

Workshop Requested

Who is your audience?

How many participants are you anticipating?

We would prefer the class to be

Hybrid

In-person

Microsoft Teams

Zoom

There is ample room to socially distance for the number of participants expected.

Proposed dates

Proposed dates
Proposed dates

The workshop I am requesting offers CEU’s. We would like to offer CUE’s for our participants