Thank you for your interest in hosting a Conversations of Your Life (COYL) workshop. COYL workshops and presentations help community members learn about and engage in advance care planning, including understanding health care options, identifying personal priorities, and accessing resources to support informed decision-making.

To ensure we can coordinate speakers, prepare materials, and provide the best possible program, please submit this request at least 6 weeks before your preferred event date.

Once your request is received, a member of our team will follow up to confirm details, discuss logistics, and answer any questions within 2-4 business days. We look forward to collaborating with you to offer a meaningful COYL workshop in your community.

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1. Organization/Host Site Name

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2. Contact Person

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4. Contact Phone Number

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5. Preferred Program Date & Time

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6. Alternative Program Date & Time

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7. Length of time for workshop (Typically workshops are between 45 minutes and 1 hour)

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8. Location/Venue Name and Address

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9. Program Delivery Method

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10. Program Format

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11. Type of Program

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12. Workshop Topic(s) Requested (Check all that apply)

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13. Requested Speaker(s) speciality/type

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14. Target Audience/Communities you Wish to Reach

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15. Program Goals / Focus Areas (Example: “Educate residents on hospice benefits” or “Facilitate advance care planning conversations.”)

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16. Anticipated Audience Size

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17. Materials Needed (check all that apply)-Optional

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18. Additional Notes / Special Requests

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