Presentation request form - University of Virginia/Charlottesville ONLY

Information

This form is for University of Virginia and/or Charlottesville area organizations who would like a facilitated discussion of the Gordie Center film HAZE or the Hoos Against Hazing program for current members of organizations. Looking for Hoos Against Hazing for Potential New Members? Click here to register for an upcoming PNM presentation!

Presentation requested (select all that apply)

HAZE documentary & discussion (hazing and alcohol overdose education)

Hoos Against Hazing for Organizations (hazing prevention)

Name of organization requesting presentation

Your Name

Your email address

Your phone number

Please provide your first choice for presentation date and time.

Presentation time

Please provide a second potential presentation date and time.

Presentation time

Presentation location - please provide address

Approximately how many people will attend?

Comments/Additional Information

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Presentation request form - University of Virginia/Charlottesville ONLY

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