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Educational Booking Form
Please fill out the information below to request a sexual health educational session with one of ASPECC's sexual health presenters.
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* Indicates required question
Email
*
Your email
Your Name and any aliases you use
*
Your answer
Your email
*
Your answer
Age of Participants
6-10
11-14
15-18
18-25
25-35
35-45
45-55
55-65
65-75
75+
Presentation Topics
Sexual Health Education
Diversity and Inclusion
What equipment will you need (if any)
Your answer
How long is your presentation?
Less than 1 hour
1-2 Hours
2-4 Hours
4-6 Hours
6-8 Hours
Other:
Clear selection
Do we have a crim check on file for you?
Yes
No, But I am willing to get one done
No, and I am not getting one done
I am not sure
I would like more information about this, please contact me
Clear selection
List 2 references (Name, Email, and Phone Number) that we can contact about you as a presenter.
Your answer
Let us know what your qualification are for this topic you are presenting on (Education, Experience, Life Experience, Other)
Your answer
Anything else you would like to tell us? If not, just hit send.
Your answer
Submit
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