宅男研究所

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宅男研究所 Health Education Resource Center

If you are requesting a program for University Foundation courses, please do so using this link: /herc/machform/view.php?id=46276

H.E.R.C. Program Request Form

H.E.R.C. Program Request Form

Note: Please place requests two weeks in advance to ensure availability of your program.

Name: Name: First Last
Department/Organization:
Campus Location/Address:
Phone Number:
Email Address:
Best Way to be Reached:

Best Way to be Reached: Phone Email
Presentation Information
Presentation Topic:
If you chose "other" above please provide a topic below.
Date of Presentation: Date of Presentation: /