School or Organization Name

Contact Person's Name

Work Phone Number

Email

Personal Phone Number
*The personal phone number will only be used if we need to get a hold of you immediately and you are not available at your work phone.

Add me to GENaustin's mailing list!

Areas of Interest

Body Image / Media Literacy College and Career Planning      Etiquette      Goal Setting Health / Sexuality Leadership / Diversity

Relationships      Communication      Dating      Dating Violence      Friendships      Parents Self-esteem building Stress Management / Yoga

Please check our workshops calendar - here.
We are only able to offer two workshops per day.

1st Choice:
Date       Time  

2nd Choice:
Date       Time  

Attendance and Selection Process:
Please list the number of girls expected to attend, their grade level, and how you will choose the group of girls who will participate in the workshop.

Program space: Please describe the space in which your workshop will take place. Is there a white or chalk board available? Desks or tables?

Is there anything you would like us to know about your school/program’s environment? Are there particular issues girls are facing that you would like for us to address? Anything else we should know?

By submitting this workshop reservation form, you agree to:

• Provide a private space for the workshop (like a classroom)
• Recruit a minimum of 10 girls
• Communicate schedule changes to a confirmed workshop at least one week in advance