PRESENTATION REQUEST FORM

Name *

First Name

Last Name

Phone *

(###)

###

####

Date of the presentation *

MM

DD

YYYY

Time of the presentation

Hour

Minute

Second

AM PM

Will this be an in-person or virtual presentation? *

In-person

Virtual

If in-person, provide the address for the engagement.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What topic(s) would you like The Policy Project to present about? *

The Period Project

The Teen Center Project

The Safe Child Project

Period Positive Workplace

Policy Change

Leadership

Other

Who would you like to present? *

Emily Bell McCormick, Founder and President

Mary Catherine Perry, Director of Policy and Government

Kristin Andrus, Community Champion

Brooke Gledhill Wood, Chief of Staff

No preference