Speakers Bureau Reporting (Post-Event)

Please submit Speakers Bureau activities by completing the form below so that we can track educational presentations throughout the year.

Alive Hospice Representative/Presenter *

Today's date

Please List Additional Speakers, if Any

Event information

Title

Guest Presenter 1 (if applicable)

Organization of Guest Speaker

Name of Organization Receiving the Presentation *

Underserved Community *

Yes

No

Type of Organization *

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Email Address

At which Alive territory was the event held? * 🛈

Date of Presentation * +

Length of Presentation (in minutes) *

Number of Attendees (estimate) *

Topics Covered (select all that apply for the date of the presentation) *

Other Topics Covered

Audience Profile (Select all that apply) *

Primary Age Ranges of Audience
(Select all that apply) *

Additional Detail of Audience, if any:

Please attach a copy of your presentation, if available:

Please attach a copy of any training materials, if available:

Alive Lunch and Learn	Civic (Rotary, Kiwanis, etc.)
Health Care Provider	Colleges and Universities
Community Organization/Non-Profit	Faith/Religious Group
Funding Source	General Community
Government	K-12
Other Other

Alive Grief Support Services	Care for the Caregiver	Children's Grief
Fundraising	Grief in the Workplace	Health Fair/Trade Show
Hospice 101	Hospice Admissions	Loss of a Child
Loss of a Sibling	Loss of a Spouse	Palliative Medicine
Pediatric Hospice	Student Orientation	Symptom Management
TGI Any Audience	The Gift Initiative 101	The Gift Initiative: Preparing an Advance Directive in 7 Steps
The Gift Initiative: Breaking the Ice	Volunteering	Other Other