Request a Program

If you would like a health-related presentation or program for your classroom, student organization, residence hall, department or any other DU organization, fill out the form below.

Please note: We require a minimum of 2 weeks notice for any event/presentation.

An asterisk (*) indicated a required field.

Contact Information

Your Name * :   Name of Organization:
 
Phone * :   Alternate Phone:
 
Email Address * :    
   

Presentation Request

Presentation Date(s) * :   Time * :
  :

Location:

Type of Audience:   Audience Count:
  people

Description of requested program / issue: