Bias Crimes Presentation Request Form - Bergen County Prosecutor's Office

Please Select a Presentation *

Organization Name (Primary) *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Approximate Attendance *

Name *

First

Last

Your Title / Position *

Phone *

Email *

Email

Confirm Email

Messages or Comments

Date / Time of Presentation *

Date

Time

As the requesting organization, I hereby submit this form indicating our interest in hosting a presentation. I acknowledge that this information will then be distributed to the Speakers Bureau of the Bias Crimes Unit. If the Bias Crimes Unit can accommodate my request, I will be notified at the contact information provided. A mutually agreeable date and time will then be confirmed. * *

I agree to the above terms.

Upon completion of this form, press submit, which verifies your understanding, agreement, and compliance with all guidelines established herein.

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