Participation/Presentation Request Question Title * 1. Providing resources to our community is our mission: to educate, engage and encourage. We welcome invitations to participate in your information presentation, fair, staff training or conference. PRC services are no costs to you and your agency. We do serve 23 East Texas counties and will work to fulfill your objectives. Participation is based on staff availability and funding.Which type of event are you considering? Health Fair Information Meeting Staff Training Student Presentation Media Event Parent Conference Other (please specify) Question Title * 2. Your Information Name: Title: Agency: Address: City/Town: ZIP: Email Address: Phone Number: Question Title * 3. County your organization is located in: (you can serve more than one county) Anderson Bowie Camp Cass Cherokee Delta Franklin Gregg Harrison Henderson Hopkins Lamar Marion Morris Panola Rains Red River Rusk Smith Titus Upsur Van-Zandt Wood Question Title * 4. Event information Event Name: Date: Start/End Time: Physical Address: Age level: Electricity available for presentation? Expected number of adult participants: Expected number of youth participants: Question Title * 5. Other information about the event: Question Title * 6. Topics to present-select all that may apply (we can discuss the details) Alcohol Community Challenges ETCADA: an overview Health Life Issues Marijuana Other Drugs Parenting Proactive Prevention Provide literature Seeking Support Smokeless Tobacco Tobacco Other (please specify) Question Title * 7. We look forward to receiving your electronic request. A PRC specialist will contact you within 1 business day. You can print this form out before you submit it for your records. Please add any additional information: Done