Request Services

Request for Therapist Participation

Event

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Event Description

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Expected Number of Attendees

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Child and Family Requested

Yes

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Event Date

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Event Time

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Event Address

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Directions to Lodge or Event location

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Is Therapists Spouse invited

Yes

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Lodge

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Describe how Staff will be asked to participate

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Will Lodge be hosting Therapist Family for meals

Yes

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Is Audio Visual equipment available

Yes

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How long is the presentation expected to last

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Host Elk

Please enter Host Elk's name

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Phone

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Additional Comments

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