Presentation Request Form
MADD West Texas Region
7500 Viscount Blvd., Suite 295
Tel: 915.779.1987
Fax: 915.779.2084
[email protected]
MADD Staff ONLY:
Form Received on: ______________
MADD Staff/Volunteer Assigned: ________________________
Request entered into Shared Drive: ______________________
Stats entered into Shared Drive: ________________________
Please note submission of this form does not confirm your event, please allow time for a
MADD staff to contact you to confirm. Confirmation on request will be sent via email.
Completed forms need to be received at least 2 weeks before presentation send to
Fax, 915.779.2084 or Email, [email protected]
*Presentations may be facilitated by a volunteer; in the event of an emergency a presentation might be cancelled or rescheduled if staff or
volunteers are not available to present on given day. MADD will provide as much notice as available in this situation.
*Schools requesting a presentation; must have staff/teachers present. Classroom management and supervision of students is the role of the
requesting school.
* If multiple presentations have been requested; please complete a form per requested presentation.
Requests must be received two (2) week prior to event – no exceptions
Today’s Date:
Event Host (Organization/School):
School District/Military Branch:
Language of Presentation:
Equipment Requirements:
Event Address with Zip Code:
Contact Name:
Telephone Number:
Fax Number:
Email Address:
Event Name:
Event Date:
Event Time:
Number of Attendees:
Audience Profile (i.e. age range,
gender, race, etc.):
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Laptop, projector, screen or blank wall, and speakers
Indicate if equipment not available so that presenters can modify
presentation or plan to provide MADD Equipment.
Presentation Request Form
MADD West Texas Region
7500 Viscount Blvd., Suite 295
Tel: 915.779.1987
Fax: 915.779.2084
[email protected]
MADD Staff ONLY:
Form Received on: ______________
MADD Staff/Volunteer Assigned: ________________________
Request entered into Shared Drive: ______________________
Stats entered into Shared Drive: ________________________
Please note submission of this form does not confirm your event, please allow time for a
MADD staff to contact you to confirm. Confirmation on request will be sent via email.
Completed forms need to be received at least 2 weeks before presentation send to
Fax, 915.779.2084 or Email, [email protected]
*Presentations may be facilitated by a volunteer; in the event of an emergency a presentation might be cancelled or rescheduled if staff or
volunteers are not available to present on given day. MADD will provide as much notice as available in this situation.
*Schools requesting a presentation; must have staff/teachers present. Classroom management and supervision of students is the role of the
requesting school.
* If multiple presentations have been requested; please complete a form per requested presentation.
Requests must be received two (2) week prior to event – no exceptions
Type of Presentation
English Presentations Only
MADDasaurus: Interactive video that provides education on impaired driving
illustrated through the character of a surfer-dino who saves a life and becomes
MADDasaurus.
Car & Brain Safety: Interactive video that provides education on brain and car
safety. It highlights on the effects of alcohol on the brain and the importance of
recognizing trusted adults.
Underage & Impaired Driving for Teens: Interactive video that provides
education on underage impaired drinking & driving with real life stories that includes
deadly consequences.
Power of You(th): Interactive presentation demonstrated as a game show with
students. The program is based on giving students the power to take a stand on
underage drinking and encourage them to set an example for their peers.
(Classroom setting only)
Victim Services & Victim Highlights: Education is provided on MADD’s Victim
Services & programs and highlights a victim story using multimedia videos.
Power of Parents: Parent workshop that provides research-based resources to talk
with their children about alcohol and underage drinking.
Speakers Bureau: Volunteer facilitated presentations to provide an overview of
MADD’s programs and services. (Upon availability)
Volunteer Program: Education on MADD volunteer program for young adults,
interns, and adults on their role to get involved to help make a difference in our
community to END DRUNK DRIVING.
DWI Mobile Trailer: The DWI Mobile trailer is a moving memorial donated by the
Lindsey family. The Lindsey family was from Seminole, Texas; the family was hauling
livestock when they were hit by a drunk driver who ran a stop sign. The Lindsey
children, Rachel (10), Madelyn (6), and Yates (1 mo.) were killed. The parents were
seriously injured and survived. The trailer that once carried livestock has now been
transformed to carry and display the red truck the Lindsey family was driving at the
time of the crash. The truck, car seats and stop sign are visible inside the trailer – the
trailer sends a very powerful message. ($250 Minimum Donation)
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Age
Group
Duration
Pre-K to
1st Grade
2nd to
5th Grade
20-30
min.
6th to
12th Grade
30-45
min.
30-45
min.
6th to 12th
Grade
30-45
min.
Adults
30-45
min.
30-45
min.
15-30
min.
Parents
Adults
18 years +
30-45
min.
3rd Grade &
Up
30-45
min.
Select