Contact name:

Organization:

Mailing address:

County:

Telephone number:

Fax number:

Email address:

Topics of presentation:

CANHR Services Medi-Cal Nursing Home Residents' Rights Residential Care Rights

Elder Abuse Issues Elder Fiduciary Abuse Family Council Other:

Date of presentation:

Start time: End time:

For how many people? (20 Attendee Minimum)

Who is the audience? (consumers, professionals, etc.)

Location of presentation (name):

Location of presentation (address):

CANHR tries to meet all speaking engagement requests. However, as of 6/1/2010, because of our limited staff and budget, CANHR is requesting a minimum of $100 honorarium, plus travel, depending on travel distance, length of presentation and materials for requesting organizations. A lower rate may be available on a sliding scale for consumer groups, depending on type of presentation.

Please check the appropriate box below.

Can Pay a minimum $100 Honorarium plus travel @ .40/mile