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COLUMBIA PARKINSON'S SUPPORT GROUP SPEAKER'S BUREAU


Is your group / organization is interested in having a FREE presentation about Parkinson's Disease? The Columbia Parkinson's Support Group has a Speaker's Bureau available to come to you. The members of the Speaker's Bureau will answer your questions and to provide information to you about Parkinson's Disease.

Our Speaker's Bureau welcomes anyone to attend our presentations regardless of race, color, and national or ethnic origin. We encourage anyone afflicted with Parkinson's disease; anyone who has an interest in Parkinson's disease; as well as all visitors, family, friends, and guests to our presentations. There is no cost to attend our presentations - they are FREE.
Meeeting Presentation
Please bring any guests with you.  The more your family, friends, neighbors, business associates, or anyone who has an interest in Parkinson's disease can learn about Parkinson's disease, the more support they can provide to the patient, caregiver, care partner, and the community. We always welcome students from our universities and colleges - and professionals from the medical community.

We have several topics about Parkinson's Disease already available to present; or we can customize our presentation just for your group / organization. To be able to meet your group / organization needs during our presentation, please complete the form below.

Want to know more about our Speaker's Bureau? For more information or questions about our Speaker's Bureau, please contact

Dave Flickinger --- Telephone: (803) 335-4247
Email: speakerbureau@columbiaparkinsonsupportgroup.org


Below is our Speaker's Bureau Request Form. Please complete the form, print it before you submit the form, and then submit the form. We will contact you, and work with you to schedule our presentation.

COLUMBIA PARKINSON'S SUPPORT GROUP SPEAKER'S BUREAU REQUEST FORM

To help us give your group / organization a positive informative presentation that will meet their expectations, please complete this form. We understand that your information may change and we will work with you to accommodate any changes you need to make.

After you COMPLETE THE FORM, please remember to PRINT IT before you SUBMIT IT.
Your Email Address

Your First Name
Your Last Name
A value is required.
Your Contact Telephone Number
If we need to contact you by phone, is there any particular time of day / evening you would prefer we contact you?

What date would you like to have this meeting?
What time would like for this presentation to take place?
Please enter the start time for the meeting (For example - 8:00 pm)


Please enter how long you would like this presentation to last
(For example - 1 1/2 hour -- or -- 45 minutes)

What is the address of where the meeting will be located?
Street Address - Number & Name

City Name

State - You may use abbreviations like "SC"

Zip Code - Please use extensions if you have them - like "0000-0000"

We would like to understand how much the audience knows about Parkinson's disease. This information will help us to customize our presentation for your audience.

Please indicate what type of group will be attending. This information will help us to customize our presentation for your meeting. For example we would not want to present an incorrect level of information to your attendees..
If we have any literature or handouts, we want to make sure we have enough for the audience. How many people do you estimate might come to the meeting?
Please enter estimate of number of attendees
What type of presentation format do you think the audience would prefer?
Please choose one of the following
Does the meeting facility have Audio / Visual equipment? For example microphone(s) and the ability to give a Power Point presentation on a screen.
Please choose one of the following
Below Are Some Of The Topics We Have Available For Presentations - You can select more than one. When we set-up the meeting, we will discuss which topic(s) you would like presented.

Parkinson's 101 - Understanding Parkinson's Disease -- The BIG Picture of What You See and Don't See

Is there any other specific Parkinson's topic you would like us to cover?
Is there anything your group would like to learn from our presentation?
Do you have any questions for us before we contact you to set-up this meeting?
 
Thank you for your interest in Parkinson's disease. We appreciate your filling out this form. We look forward to working with you to plan a presentation meeting for your group. For more information or if you have any questions about our Speaker's Bureau, please do not hesitate to contact:
Dave Flickinger --- Telephone: (803) 335-4247
Email: speakerbureau@columbiaparkinsonsupportgroup.org
Click below to RESET / CLEAR all of your information on this form.


  Click below to SUBMIT your form.





 
   
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