2024 Chavis Housing, Health, and Wellness Day Logistics
Please complete and submit this form by April 7th.
Presenter Name
*
First Name
Last Name
Presenter Email
*
example@example.com
Presenter Phone Number
*
Enter best number to reach you on 4/27.
Website
Business / Organization URL or Your LinkedIn or Instagram Link
Please describe your activity or list your presentation title.
Business / Organization Name
Is your organization part of the Public Sector (government, municipality)?
*
Yes
No
If you are not presenting on behalf of a government agency and/or municipality, then you or your organization may be eligible to receive an honorarium. Please indicate the preferred Payee below:
*
Use the above listed Presenter Name
Use the above listed Business / Organization Name
Your Mailing Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Logistical Needs
I have a presentation, and will need laptop and projector
I have a presentation, and will only need a projector
Speakers and Music (list preferred songs below)
Speakers Only. I'll bring my own music.
Internet Access
Other
Additional Needs, Concerns, or Questions
Submit
Should be Empty: