Request a YWCA Richmond Speaker Please fill out this form to request a member of our outreach team at your event. You may contact Greisy Gil at ggil@ywcarichmond.org if you have any difficulties with this form. Name(Required) First Last Name of Organization/Group (If applicable)Today's Date(Required) MM slash DD slash YYYY Date of Presentation(Required) MM slash DD slash YYYY Note: If you are requesting a lecture or workshop, weekdays are preferred.Email(Required) Preferred Phone Number(Required)Select a Workshop Topic OR Resource Table:(Required)YWCA Richmond Resource TableSexual Assault AwarenessDomestic & Intimate Partner ViolenceYWCA 101 PresentationHealthy Relationships & Teen Dating Violence AwarenessWill you have a computer and projector available for our representative?(Required)YesNoN/A - I am requesting a resource table.Is internet available at your site for our presenter?(Required)YesNoEvent InformationEvent Location(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional Location Details (i.e. Room #, Parking, etc.)Time of Presentation / Event(Required) Hours : Minutes AM PM AM/PM Desired Workshop / Event Length(Required)How long will you have for our speaker? (indicate minutes or hours)Type of Audience (i.e. High School Students, Employees):(Required)Estimated # in Audience(Required)Why are you requesting a YWCA Richmond representative for your event?Any additional considerations?
