Hearit Workshop Request Form
Name
Title
School/Agency
Mailing Address
City
State
Zip
Phone
Cell Phone
FAX
E-mail
Location Address
Name of Location
Workshop Agenda
Set-up/break down of equipment activity
Hands-on activity
Hearit Phonologic amplifications tools presentation
Afforda Speech Presentation
Equipment necessary
Power point projector, screen, hook-up
Electric hook-up (at podium & tables)
Tables (hand-on, set-up activities)
Podium or presentation table
Time Proposed
9:30-11:30
11:30-1:30
1:30-3:30
Other
Date
Number of Participants
Describe audience