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Community Education Workshop/Training
Information Form

If you are interested in having the Children of the Camps Documentary and Educational Project present a workshop, training or screening to your group or community, please fill out the following form.

You may fill out this form online and send by clicking on the submit button, or you can print it and send by fax or by U.S. mail to:


Contact Name:
Organization:
Department:
Street Address:
City/State/Zip:
Phone:
Fax:
E-mail:



Your preferred workshop format (check one):
General Question and Answer (screening + 1 hour)

Dialogue Group (screening + 2 hours)

Workshop Intensive (screening + 7 hours)

Training for Mental Health Professionals/Students (screening + 4-8 hours)

Requested date(s) of screening/workshop
(please list alternative dates in order of preference):


Proposed Time of screening/workshop:



Screening/workshop will be open to the public? (check if yes)

If open to the public, could we list this event on our Web site? (check if yes)

For events not open to the public, may we publish the details on our Web site after it’s over? (check if yes)


Event location (provide complete address):


Cost for attendance, if any:


Anticipated number of participants:


Audience profile (i.e., church members, college professors, mental health providers, senior citizens, etc.):




Type of facilities available:


Number of breakout rooms available, if any:


Is TV and VCR or projection system available? (check if yes)

If yes, please describe:

- size of screen


- format of tape needed:



Would you like any of the following written materials to help facilitate your outreach or publicity?
(check all that apply):

Children of the Camps brochure(s)

Community Education Workshops information

Video distribution/purchase information

Master flyer w/space for your organization’s event

Newspaper articles

Press releases


Any other comments or questions?


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