Exit Survey
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Please submit your form at least two weeks prior to the event.
Organization:
Contact Information
First Name
Last Name
Phone
Email Address
Preferred date of the event:
Start time:
End time:
Second choice date:
Start time:
End time:
Expected number of attendees:
For presentations for students only, please enter their grade or age:
Location:
Address Line 1
Address Line 2
City
State
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Arkansas
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Colorado
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Hawaii
Idaho
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New Hampshire
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Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Zipcode
Please choose the type of presentation or event you are interested in::
Japanese culture and language - a general presentation (recommended for K-12)
Japanese cooking class
Calligraphy workshop
Doing business in Japan - cross-cultural workshop
Schools in Japan - presentation
Seasonal events in Japan - presentation
Origami workshop
Study abroad in Japan - informational session
Other / I'm not sure.
What are the learning outcomes for your event? What are your goals? (OPTIONAL)
Available technology
Projector
Speakers
Microphone
Computer
Screen
None of the above
Other important information about the location (e.g. room layout, available furniture, available materials or supplies, etc.)
Is the hosting organization willing to offer any supplies, materials or reimburse the costs of mileage or supplies? (OPTIONAL)
Special requests or needs:
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