RAIN Event Intake Form

Please fill out this form if you would like to request RAIN attendance at an event or speaking opportunity.

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* 1. Full name

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* 2. Work Email

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* 3. Work Phone number

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* 4. State Agency/Team/BRG/Group

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* 5. What type of event are you requesting?

Tabling Event/Conference

RAIN 101 Presentation (approx 20 min)

Specific Topic Speaking Opportunity

Panel Member (Represent RAIN on a Panel)

Other (please specify)

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* 6. Is requested attendance in-person or virtual?

In-Person

Virtual

Hybrid/Either

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* 7. Date

Enter Date of Event or a Preferred Date

Date

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* 8. Is the above date flexible?

Yes

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* 9. Preferred time

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* 10. Is the above time flexible?

Yes

RAIN Event Intake Form

Question Title

* 1. Full name

Question Title

* 2. Work Email

Question Title

* 3. Work Phone number

Question Title

* 4. State Agency/Team/BRG/Group

Question Title

* 5. What type of event are you requesting?

Question Title

* 6. Is requested attendance in-person or virtual?

Question Title

* 7. Date

Question Title

* 8. Is the above date flexible?

Question Title

* 9. Preferred time

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* 10. Is the above time flexible?

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* 11. How long will the event/presentation/speaking be?

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* 12. Who is the intended audience?

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* 13. Notes or special requests

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* 14. Any additional comment/question?