Request a Presentation - Council on Chemical Abuse | Your Bridge to Addiction Resources

First & Last Name*
Email*
Phone*
Who is the intended audience? (Elementary students, college students, parents, educators, employees, etc.)
Number of students/participants expected
What topic would you like the presentation to focus on?
First Choice for Date
Month
Day
Year
Time

: Hours

Minutes

AM/PM
Second Choice for Date
Month
Day
Year
Time

: Hours

Minutes

AM/PM
Presentation Location (If you need to reserve a space, please list as TBD.)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Is there any additional information about this group/presentation you would like to share with us?
CAPTCHA