Request a Speaker or Information Table Speaker or Information Table Request Please note: We appreciate four - six weeks notice for speaker requests. Thank you for your consideration. Name * Required First Last Organization or Group Email * Required Phone * RequiredDate of Event - must be mm/dd/yyyy format MM slash DD slash YYYY Alternate Date (if available) - must be mm/dd/yyyy format MM slash DD slash YYYY Time of Event Location of Event Street Address Address Line 2 City What are you looking for? * Required An information table (my event does not require a speaker) A presentation about services at CMHA Middlesex A presentation about a topic from your Public Educator (please see below) Volunteering opportunities Information about a specific program Impact speaker or individual with lived experience Certification Training (Fees may apply) If you requested a presentation from our Public Educator, please select a topic. * RequiredNote, if you are looking for a topic that is not listed, please enter in the comments at the end of the form. There may be a fee in this case. Mental Health 101: Workshop on Improving Mental Health Literacy Suicide Awareness Stigma Understanding and Coping with Stress Wellness and Self-care Strategies to support de-escalation Depression Introduction to Psychosis Anxiety Disorders Overview Bi-Polar Personality Disorders Other Certification Training CoursesNote: We require a minimum of 10 people for these trainings. We also offer them regularly at the Mind Full Nest. You can find the schedule and online registration at www.cmhamiddlesex.ca/learn. Fees apply. Mental Health First Aid safeTALK What AV equipment is available at this venue? Sound System/Microphone Projector and Screen TV Other Who will be in the audience? * Required Service providers/volunteers Family members/caregivers Business/Staff School General Public/Mixed Is this event being publicized?YesNoNot SureIf you answered yes, please list any social media or websites where we can find or share the event information.