Request A Presentation

NCCEV has many presentations that can be tailored to fit the needs of the requesting organization. If you are interested in having a team (clinician/police officer) present at your conference, please submit the following form and a member of our staff will contact you to discuss the availability of our resources and staff, related fees, and other details.

	Event Information
	Date of event:	(MM/DD/YYYY)
	Location:
	Sponsor of event:
	Brief description:
	Anticipated number of attendees:
	Discipline of attendees:
	Is there reimbursement for travel expenses? Yes No
	Is there an honorarium? Yes No
	Are you requesting a team for a keynote (which is given to the entire conference) or a workshop (for those conference attendees who sign up) or a panel discussion? Keynote Workshop Panel
	Length of time for presentation:
	Theme or focus of conference:
	Contact Person
	Last name: First name:
	Address:

	City State Zip
	Phone:	( ) - Ext.
	FAX:	( ) -
	E-mail:
	Additional notes about the conference:
	Thank you!

For additional information, call the NCCEV at 203-785-7047 or email nccev@info.med.yale.edu