Youth / Young Adult Speaker Request

Today's Date

Virtual / In-person Presentation *

Virtual
In-Person

Contact Name *

Address *

Address Line 1

City

State

Organization/School *

Daytime Phone *

Email *

Preferred Classroom / Virtual Presentation Dates *

Separate preferred dates by comma

Start Time (In-person)

End Time (In-person)

Number of Students *

Number of Adults *

Number of Classroom Presentations *

Grade(s) *

Can you provide a computer, projector, and screen? (In-person)

Can you provide a TV, VCR, and DVD player? (In-person)

Additional information or expectations

Phone

Thank you for your request. Someone will contact you soon. If you have any questions please contact us at 920-437-8888 or
outreach@wi-problemgamblers.org.

The Wisconsin Council on Problem Gambling provides resources, public awareness, and education on gambling disorders while maintaining strict neutrality on the issue of legalized gambling.