Event Request

Contact Information

First Name*:
Last Name*:
Email Address*:
Cell Number*:	() -Second partThird part
Alternate Number:	() -Second partThird part

Event Information

Date*:	Date and time
Event Time*:
Length of Time of Presentation:
Group:
Audience Type:	Select General Public Professional Organization Youth Audience College Students Seniors Civic/Non-profit Government Other
Projected Attendance:
Speech/Booth:
Speaker:
How are you marketing this event?:
Topics:	Cybersecurity/ID Theft Internet Safety for Adult Audience Internet Safety for Youth Audience Scams and Frauds Student Loans Domestic Violence/Sexual Assault Hate Crimes Criminal Justice Issues Auto Loans Human Trafficking

Event Location

Location:
Street Address:
City:
State:
Zip Code:
County:	Select Alamance Alexander Alleghany Anson Ashe Avery Beaufort Bertie Bladen Brunswick Buncombe Burke Cabarrus Caldwell Camden Carteret Caswell Catawba Chatham Cherokee Chowan Clay Cleveland Columbus Craven Cumberland Currituck Dare Davidson Davie Duplin Durham Edgecombe Forsyth Franklin Gaston Gates Graham Granville Greene Guilford Halifax Harnett Haywood Henderson Hertford Hoke Hyde Iredell Jackson Johnston Jones Lee Lenoir Lincoln McDowell Macon Madison Martin Mecklenburg Mitchell Montgomery Moore Nash New Hanover Northampton Onslow Orange Pamlico Pasquotank Pender Perquimans Person Pitt Polk Randolph Richmond Robeson Rockingham Rowan Rutherford Sampson Scotland Stanly Stokes Surry Swain Transylvania Tyrrell Union Vance Wake Warren Washington Watauga Wayne Wilkes Wilson Yadkin Yancey

Describe technology available and room set up:  

Thank you for completing this form. After processing, we will contact you to let you know if we will be able to accommodate your request.
 
If you are trying to schedule an event on short notice (7 days or less) or you have a question, please call (919) 716-6780.
 
If we are able to accommodate your request, please note that NCDOJ Employees are not allowed to accept “Thank You” gifts of any kind.
 
However, we would greatly appreciate any written comments or feedback you may offer after the event.
 
Thanks,
The Outreach Team
NCDOJ