Pain BC Educational Presentation Request Form

Thank you for your interest in booking an educational presentation from Pain BC for your group or organization. Pain BC offers short presentations on a variety of topics related to chronic pain, facilitated by our experienced program staff. These presentations can be customized to suite your group's needs and background. Please complete the form below with as much information as you have about your requested presentation. We ask that you provide us with a minimum of 30 days' advance notice before your requested presentation date. Requests made outside of these time frames are still considered and are subject to the availability of education team members. If you have questions, please contact us at education@painbc.ca

Organization and Contact Information

Name of organization*

Address of organization*

Contact person name*

Contact person email address*

Contact person phone number*

Presentation Information

Please fill out as much information as you have about the requested presentation.

Presentation type*

Select

Requested presentation date*

Requested presentation start and end time*

Expected number of audience members

Audience make-up (general public, health care providers, other)?*

Our presentations are delivered in English. If the audience's primary language is not English, will translation or interpreting services be provided?

The audience's primary language is English

Translation/Interpreting services will be provided

Translation/Interpreting services are not available

What type of event is this?*

Select or enter value

Format of presentation*

Select or enter value

Where will the presentation take place?

Please provide details of the technical set up of the venue (ie, do you have a projector and screen we can use)?

Would you like the presentation to be pre-recorded or live?*

Select or enter value

Key items for the presentation

Please list 2-3 topics you would like the presenter to cover during their session

Send me a copy of my responses

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