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Request a Speaker


Please fill out the following form to request a speaker at your upcoming group meeting. 
Name of Event  *
Date of Event  *
Start Time of Event  *
End Time of Event  *
Alternate Date  *
Event Location  *
Number of People Attending  *
What does your club/group do?  *
Will there be a TV/VCR available? 
Will there be a meal provided for the speaker? 

Contact Information


Contact Name  *
Organization Name  *
Daytime phone number  *
Email address  *