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Request a La Piñon Presentation or Speaker at your Event

Please complete and send this request form, then call 575-526-3437 to confirm it has been received.

Contact Person/Organization:
Phone Number:
E-mail:

Presentation Location:
Address of Presentation:
Number of Presentations:
Presentation Date(s) / Time(s):
Number of Participants:
Age Range of Participants:
In English or Spanish:

Type of organization/agency presented to (check all that apply)
Elementary School	Middle School	High School
University/College	Private Organization	Religious Organization
Community Center	Public Service Agency	Senior Citizen Agency
Immigration Agency	Child care	Advocate Training
Law Enforcement	Medical Agency	Military
Safe Environment	Sexual Misconduct	TCC
		McGruff

Explain the nature of the presentation (training, informational, etc.)

Topic of Presentation (check all that apply)
Advocacy	Effects of Sexual Assault	Media Literacy
Body Safety	Elderly Abuse	Male Involvement
Borderland Issues	GLBT Issues	Male Victimization
Bullying	Grooming Process	NM Laws
Child Sexual Abuse	Internet Safety	Prevention Puppet Show
Child Sexual Development	Intimate Partner Violence	SANE Project
Duty to Report	Kid Talk Help Line	Sexual Assault
Sexual Harassment	Substance Use Related Assault
Other Topic:

Additional Comments:

24-hour Crisis Hotline * S.A.N.E. Unit * Donate Now * KidTalk Warmline *