Safe Bars Request Form, 2021-2022

The Blue Bench is an approved practitioner of Safe Bars, project of Collective Action for Safe Spaces (CASS) and Defend Yourself in Washington, D.C., offers staff working in alcohol-serving establishments training to recognize and respond to incidents of sexual harassment and assault.

Please note: This program is not being offered virtually at this time. We will continue to follow CDC Guidelines for all in-person programs.

Please take a moment to tell us about your interest in our programming, and we'll be in touch shortly!

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* 1. Address

Name *

Company Name(s)

Address

City/Town *

State/Province

ZIP/Postal Code

Email Address *

Phone Number *

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* 2. I would like to:

Receive information about this program by email

Book this program

Discuss this program with a staff member by phone

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* 3. Our programs will have a capacity of up to 40 participants per program. Please list how many participants you anticipate for programming:

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* 4. If you would like to book a program for a specific date (or date range), please list the date(s) and time(s) here:

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* 5. Which of the following best describes your establishment?

Nightclub

Upscale Bar

Bar & Grill

Casual Neighborhood Pub

Brewery

Other (please specify)

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* 6. What is your job title or role?

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* 7. Where did you hear about The Blue Bench Prevention and Education programs?

Internet Search

The Blue Bench Website

Email or Newsletter from The Blue Bench

Referral from Another Organization

The Blue Bench Hotline

Social Media

Pamphlet/Print Materials from The Blue Bench

Friend or Colleague

Other (please specify)

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* 8. Please share anything else you would like us to know about how we can meet your needs.

Thank you for your interest in The Blue Bench's Pathway to Prevention. We look forward to partnering with your organization to prevent sexual violence!