OD Free Marin Training, Tabling & Presentation Request Form

Thank you for contacting OD Free Marin to request an overdose prevention training, naloxone tabling at an event, or a presentation about our work. In order to submit your request, please complete this form to the best of your ability. A representative from OD Free Marin will respond to your request using the contact information below within a week of receiving this submission.

Please note: A request is not confirmed until you receive a correspondence from OD Free Marin with the written confirmation including location, time and details of our participation.

All information provided in this form will be stored securely and be reviewed only by internal OD Free Marin program staff to assist with your request. If you have any questions or additional information to provide, please contact info@odfreemarin.org

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Request Type

Overdose Prevention and/or Naloxone TrainingEvent Participation and/or Naloxone TablingPresentation about the Work of OD Free Marin

Date & Time of Event(s)

Location of Event(s)

Your Organization's Name

Type of Organization/Group

Organization URL or Event Website

Demographics of Clientele/Audience

Presentation Delivery

In-personVirtual

How many people will attend the presentation/event?

Please provide any additional details that will help us prepare for participation. For example, audience/clientele demographics (occupation, ages, literacy). Please be specific. Example: "We would like a presentation for our childcare providers at a staff meeting," or, "We would like tabling at our high school's student wellness fair."

Training, Tabling, and Presentation Request Form