University of California Irvine
Lesbian, Gay, Bisexual, Transgender Resource Center

Workshop Request Form

Please fill out all the information below. You will be contacted by a member of the Speaker's Bureau to confirm your workshop request and to gather any other details. If you have any questions regarding this form or the workshops please call 949-824-3277 for assistance. 
 

Organization/Class:
Contact Person:
Phone:
 
E-mail:
Location of Workshop:
Date:
Time:
 
Check here if the date and time is flexible
Approximate length of workshop:
 
Number of people:
Demographics of audience (i.e. age range, fields of study, diversity, etc..):
Topic Requested:

Areas you would like specifically addressed:

Purpose of workshop (Why do you want this workshop? What do you hope to achieve?):

Any other pertinent information: