Presenter's Outline

Thank you for your interest in conducting a workshop/presentation with Diamond In The Rough. Please provide details on your proposed workshop/presentation. Once submitted, our team will review and follow up with you based on our program needs.

* Indicates required field

Date: *

Name *

First

Last

Phone: *

Cell Phone: *

Company/Organization (if applicable): *

Website: *

Address: *

City: *

State: *

Zip: *

Email *

Emergency Contact: *

Emergency Phone Number: *

Presentation Title: *

Presentation Description: *

Please outline the primary points of your presentation: *

Do you have an specific supply or technological needs (I.e. projector, speakers, whiteboard, etc.)? If so, please provide details: *

Please indicate appropriate grades for your presentation (check all that apply): *

The maximum number your workshop/presentation will accommodate: *

Are you willing to conduct your presentation in multiple rotations? *

Yes No

Indicate room set-up (select one): *

Do you have any special dietary needs? *

Do you have any additional special requests or concerns? *

Submit