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Dr. James Still Historic Office Site Association Presentation Request Form
Please complete the form below to submit your presentation request.
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Email
*
Your email
What is the name of the organization or school?
*
Your answer
Contact Information
Please enter information below for the presentation's point of contact.
Full Name
*
Your answer
Phone Number
*
Your answer
Presentation Details
Please indicate the type of presentation requested.
*
Site Tour
Virtual
Off-Site
Other:
If off-site, please provide the address where the presentation will be given.
Your answer
What is the date of the presentation?
*
MM
/
DD
/
YYYY
What is the scheduled time of the presentation?
*
Time
:
AM
PM
What is the approximate number of attendees?
*
Your answer
What is the age or school grade of the attendees most likely attending the presentation?
*
Your answer
How much time is allocated for our presenter?
*
Your answer
If off-site, please describe the media equipment that will be available to the presenter?
Your answer
If off-site, please describe the size of the space where the presentation will take place. (auditorium, classroom, etc.)
Your answer
If off-site, will we be allowed to sell books and t-shirts after the presentation?
Your answer
If off-site or virtual, is there an honorarium for the presenter?
Your answer
Please provide additional notes/details, if available.
Your answer
Thank you for your request!
Dr. James Still Historic Office Site Association
210 Medford-Mount Holly Road, Medford, NJ 08055
www.drjamesstillcenter.org
A copy of your responses will be emailed to the address you provided.
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