Name of Organization or Department * Contact Person * Please tell us who to contact about this workshop request. Include first and last name. Phone Number * The phone number of the contact person. Email * The email of the contact person What type of program would you like to schedule? * Women's Self-Defense Workshop Coed Self-Defense Workshop Date Range * We request at least two weeks notice to schedule classes. What is the date range you would like to offer the class? Preferred Day of the Week * What days of the week work best for you? Please select your top two options. Monday Friday Tuesday Saturday Wednesday Sunday Thursday Preferred Start Time * When would you like the workshop to start? Please list your top two options. Note that workshops on Mondays–Thursdays can only start after 3:00 p.m. Number of Participants * How many participants are you expecting? We require a minimum of eight participants to hold a class. Participant Demographics * Please describe the demographics of your group. Include any special needs or accommodations needed for group members. Group Goals What are the goals of the group for this workshop? Questions or Comments?