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

"*" indicates required fields

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

Time

Second Choice for Date

Time

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?