LVPG Sports Nutrition
Educational Talks, Outreach and General Questions
Name:
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First Name
Last Name
Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender:
Please Select
Male
Female
Transgender
Non-binary/non-conforming
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Phone Number:
*
Email:
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Confirmation Email
Athlete Grade:
Athlete School:
Athlete Sport:
Type of Event:
*
Workshop
Presentation/Nutrition Talk
Outreach
Event Keynote Speaker
Other
Type of Requestor:
*
Middle School
High School
College/University
Club
Community Non-Profit (e.g. YMCA, Boys & Girls Club)
Youth Sports Community Organization
Professional Team
Other
General questions:
Event Title:
Event Date:
-
Month
-
Day
Year
Date
Event Start Time:
Hour Minutes
AM
PM
AM/PM Option
Event End Time:
Hour Minutes
AM
PM
AM/PM Option
Event Address/Location:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Anticipated number of guests/participants:
Presentation/Staff Education Comments:
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Should be Empty: