JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Request a Defender
Would you like someone from the Defender to lead a workshop, or provide services or information at your upcoming event? Please submit this request form and we will make every effort to be there!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your Organization's Name
*
Your answer
Organization's Address
*
Your answer
Name of Primary Contact Person
*
Your answer
Contact Person's Email Address
*
Your answer
Contact Person's Phone Number
Your answer
Date of Your Event
*
MM
/
DD
/
YYYY
Your Event's Start Time
*
Time
:
AM
PM
Your Event's End Time
*
Time
:
AM
PM
Location of Event (if different than your organization's address
Your answer
How Can Defender Support Your Event?
*
Review records and determine expungement eligibility
Table at the event and provide general information
Participate in a Panel Discussion
Attend a Press Event
Lead a Community Education Session
Other
Required
If you checked "Other" in the previous question, please explain what you would like Defender to provide
Your answer
Does your location have reliable WIFI / access to electrical outlets?
Yes
No
Not sure
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Defender Association of Philadelphia.
Report Abuse
Forms
