Gang Awareness Presentation Request Form - Bergen County Prosecutor's Office

Please Select a Presentation:

Grade Level:

Organization Name (Primary):

Address of Presentation:

City

State/Province

Zip/Postal

Date of Presentation:

Time of Presentation:

Approximate Attendance:

*PLEASE NOTE: Presentations can only be scheduled on Fridays.

Your Name:

First

Last

Your Title / Position:

Preferred Phone Number:

Preferred Email Address:

Message / Comments:

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 Gang Task Force. If the Gang Task Force can accommodate my request, I will be notified at the contact information provided. A mutually agreeable date and time will then be confirmed.

Acceptance of Terms:

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.

Gang Awareness Presentation Request

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