Request a Workshop

Name of School/Organization **

Address **

Would you like an in-person or virtual workshop? **

Contact Name **

Contact Person's Position **

Email **

Phone Number **

Fax Number

The Participants Will Be (please check all that apply): *

Elementary School Teachers
Middle School Teachers
Secondary School Teachers
Support Staff (SEA’s, TA’s, etc.)
Early Childhood Educators
Students
Other (Please Specify)

If Other, Please Specify

Number of Participants **

Workshop Date (We offer Epilepsy Workshops throughout the year. Please book as far in advance as possible to ensure that we’re able to meet your requested date): **

Workshop Time (We are able to offer Epilepsy Workshops at various times for your convenience. This includes evening and weekend bookings.) **

The ideal length for the workshop is 90-120 minutes. If you require a shorter workshop length, please indicate it here and we may be able to provide a summary/shorter workshop:

What Audio/Visual Equipment is Available? **

Is there a specific concern or need that has prompted you to make this request? Please describe.

How did you hear about Epilepsy Workshops hosted by the BC Epilepsy Society?

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