Brain Awareness Event Request

EVENT REQUEST

Required (*)

Requested Event Date(s)

*  (e.g. mm/dd/yyyy)

*  (e.g. mm/dd/yyyy)

*  (e.g. mm/dd/yyyy)


SCHOOL/COMMUNITY ORGANIZATION INFORMATION

*

*

*

*

*

*  (e.g. First, Last, Suffix)

*

*  (e.g. xxx-xxx-xxxx)

*


BRAIN OUTREACH EVENT DETAILS

(e.g., neuroscience of the senses, drugs and the brain, basic neuroanatomy, etc.)
*

*

*

*



*Is a team of volunteers requested, or a single person?
  

*Preferred time of day?
        

*Number of hours for program?
        

*Are media personnel welcome?  (e.g., reporters from local newspapers and/or newstations)
  

*May a Brain Awareness photographer take photos at the program?
  

*Are individual photo release forms required to use the photos on BAW materials?
  

*Have Brain Awareness volunteers visited your school/community organization before?
  

   

Questions? Contact Becca Parker at parker.becca@utah.edu or 801-585-0727.

 

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