Request for Nutrition Program for Group or Team
Copy this form, fill it out and e-mail it to CampusRecNutrition@niu.edu
I would like a speaker on the following nutrition related topic: (choose one)
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General discussion on healthy eating
Myth versus fact challenge
Menu planning and recipe selection
A cooking class
Weight control
The endurance diet for athletes
Dining out
Disordered eating and Eating disorders
Other (please specify ______________________)
Requestor Information
Name:
Group:
Phone number:
Email address:
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Program Information:
Desired date ______________ mm/dd/yy and ______________ time
Please indicate at least 2 alternative dates
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________________ or ______________
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Desired length of talk (choose from the following options:
 20 minutes plus 10 minute discussion
 40 minutes plus 10 minutes discussion
 20 minute presentation with a 20 minute follow-up at a later date (specify both
dates)
Meeting location
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Check here if requesting meeting room at Campus Recreation__
If further questions, contact the Nutrition Programming office MWF at 815-753-9416 or
CampusRecNutrition@niu.edu