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CRISIS LINE
510-536-7233 
(510-536-SAFE)
 
BUSINESS OFFICE
510-986-8600 
 

 
 
 
 

To request a presentation for your staff or community group, please complete and submit this form.

Please note that submission of this form is not a workshop confirmation. A presenter from A Safe Place will contact you to finalize dates and times, and confirm details. Please feel free to contact us with any questions.

 

Contact info

  

Contact Name:

Title:

Phone:

Fax:

e-mail:
 

Organization info

  

Organization Name/Location of Workshop:

Address:

Cross Street:

City:

Zip:
 

Participant info

  

Minimum number of participants:

Maximum number of participants:
 

What are some of the strengths of your group?

 

What might be some challenges for outside presenters?

 

Are there any special needs or concerns in the group?

 

Please list at least two possible dates

 

Please describe the desired starting and ending times. Please allow at least 60 minutes.

 

How did you hear about us?

 

Any additional comments

 
 
 
 
 

A Safe Place

Mailing Address: P.O. Box 23006, Oakland, CA 94623-0006

Phone: 510-986-8600 / Fax: 510-986-8606
Business/Counseling Center Hours: Mon - Thurs 8:30 am - 4:30 pm, Fri 8:00 am - 4:00 pm
Hotline 24-hours 510- 536-7233

A Safe Place  is a non-profit 501[c] 3 organization, Federal Tax ID # 94-2491881

If you have questions, please send us e-mail (and please include your phone number!):

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