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Black Dog Institute

Community Education Booking Request Form

 
 
Thank you for your interest in our Community Education Seminars. Once you submit your details, we will be in touch to discuss your request.

Bookings are not confirmed unless you have received a confirmation email from the Black Dog Institute.

For corporate or government engagements, minimal fees may apply - we will contact you with a quote before confirming your booking.

Please be aware that due to location or availability, it is not always possible to send a speaker to deliver presentations. In such cases, we may offer alternatives of online modules.

First name: *
   
Last name: *
   
Organisation (if applicable):
   
 
Email: *
   
Phone: *
   
Mobile:
   
 
Venue/event address
Street: *
   
Suburb: *
   
State: *
   
Postcode: *
   
 
Nature of event:
 
General Guest Speaker
 
Support Group
 
Expo/Conference
 
Fair Day
 
Personal Development
 
Other
    
 
Event date:
   
 
 
Event time: *
   
Audience size: (We usually request a minimum of 10 people, however we are happy to discuss smaller size in certain cases) *
   
 
Please select the presentation you would like to book:

 
Understanding depression, bipolar disorder & wellbeing
 
Navigating teenage depression
 
You would like to have an information stall?
 
Yes
 
No
 
Any special requests?
   
 
What equipment is available for us to use at the venue? (tick all that apply)
 
Laptop/computer
 
Projector
 
Screen
 
Microphone
 
Videoconferencing facilities
 
Webcam/ Skype
 
Table & chairs for Info Stall provided?
 
How did you hear about our Community Education Program? *
 
Black Dog Institute website
 
Black Dog Institute employee
 
Family/friend
 
Newspaper
 
TV
 
Other (please specify)
    
 
Thank you! We will be in touch soon to discuss this booking.


If you would like to find out more about how the Institute can engage with your local community,
please contact: KATE HILLE on 02 9382 8320 or kate.hille@blackdog.org.au


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