Presentation Request

presentation request form

If your business, group or organization is interested in a presentation by a representative from Canine Companions for Independence, please complete the form below and make sure to inlude any important details in your request in the comments section. Thank you for your interest in Canine Companions.

* required information
Contact 
Contact Information
Company Name:*
Title:
First Name:*
Last Name:*
Job Title:
Email:*
Phone:
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
How did you hear about us?:
Preferred day(s) of the week: Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Any
Additional Information
Please include any additiontal details regarding your presentation request.
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