Donate Now
 

Bring a MediaWise Speaker to Your Community!

Fill out this form or call 1-888-672-5437
*First Name:
*Last Name:
*Email Address:
*Organization:
*Address:
Address 2:
*City:
*State:
Zip:
*Contact Phone:
Fax:

Contact name (if different):

*Location of event:
*Date and Time you would
*like the presentation:
*Topics you would like discussed at the presentation:
Other Topic:
(Must relate to the Institute's Mission: To maximize the benefits and minimize the harm of the media on the health and development of children and families.)
*Audience Size:
Audience Type (check all that apply):
Educator - Elementary School Administrators Parents and/or Caregivers
Educator - Middle School School Principals Social Services
Educator - High School Professional Associations Business/Community
Educator - College Healthcare Professional Other
Early Childhood Professionals State/Local/Government Agency
Other Type:
Will this be a: Keynote Workshop
*Length of presentation:
* Check box if open to the public.
Preferred Speaker:
Budget Amount:
Comments/Special Requests:
Check this box if you do not want to receive news and information about programs, services and products from the National Institute on Media and the Family.
 
 
 
 
© National Institute on Media and the Family.