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Request Form
Request Form
Speaker's Bureau Request Form
Scheduling Information:
Contact Name
Organization
Address
City
State
Zip Code
Phone
Type of organization
Email Address
Program Specifications:
EFS Topic(s) (
Please see topic list
)
Location of Event (Include full address)
Possible Date(s)
Possible Time(s)IE:10:00 AM-11:00 AM
Length of Time available for Presentation
Number of Attendees
Age Group of Attendees
Education Level of Attendees
Event Description:
Please give a brief description of the event.
Equipment Needs*:
Electrical Outlet
Laptop/Computer (full)
Projector (full)
Table
*Note: Please plan on providing a projection screen or wall for presentation projection.