Lunch 'N Learn Interest Form

If you prefer to download and print out our interest form, click here.
Business Name
Business Address
Contact Representative Name
Email
Phone
Subject Matter/Why it Serves Our Members
Where would you like to hold your presentation?
Date Requested
Time
Format of Presentation
Needs for Presentation (select all that apply)
 Kitchen Area
 Community Room
 Tables/Chairs
 Small Wipe Board
 TV Screen
Demographic(s) Preferred for Presentation
 Active Older Adults
 Adults
 Women
 Men
 Families
 Other
Please explain why you would like to speak to this demographic.

 

Presentation Agreement
 I understand that my company/business will be providing the food, drink, utensils, etc for the presentation. You are asked to be on-site 30 minutes early for set up.
 I understand that my company/business cannot sell or vend any items during the presentation. Business cards/coupons/contact information can be handed out for follow-up OUTSIDE of the allotted 60 minute presentation time. Time must include a 35 minute educational portion.
 The YMCA of Southeastern North Carolina, at its discretion, for reasons disclosed or undisclosed may cancel the presentation. The YMCA will do everything in their power to give enough notice to the business and participants. The business must give seven days notice to cancel the event.
 I understand participant contact information is solely the responsibility of my business/organization. The YMCA of SENC will not provide any contact information or list. The organizationis responsible for getting a sign in list to the Membership Director following tohe presentation. This is to ensure future seminars and possibly funding for additional future programming.
 I understand the YMCA of SENC will provide marketing – both in-house and online, space, tables and chairs.
 I understand this event is NOT confirmed until I receive Email confirmation with date/time/room reservation.
Signature Date