Event Request Form

Crisis Number.
Free. Confidential. 24/7
313-474-SAFE
Crisis Number.
Free. Confidential. 24/7
313-474-SAFE

If you would like Avalon Healing Center to provide training at your event, please fill out the event request form below.

    Requesting Party (Individual / Organization) *

    Your Email *

    Co-Sponsors (If Applicable)

    Event / Training Contact Person *

    Contact Phone Number *

    Event Date

    Event Time Allotted

    Topic(s) Requested *

    Purpose and Goals of Event / Training *

    Location of Event / Training *

    Parking / Security / Special Instructions

    A/V Setup Available? *

    Expected Number of Attendees *

    Participant Demographics

    Were there any incidents that occurred within your organization or with an individual that prompted this request? *

    if Yes to Above, Please Explain