Wufoo
Speakers Bureau Presentation Request
To request a Spectrum Speakers Bureau Presentation for your class or organization, please fill out this form at least 3 weeks in advance.
Name
*
First
Last
Phone
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Other Phone
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Email
Location of Presentation
Date of Presentation (first choice)
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DD
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YYYY
Time of Presentation
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:
MM
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SS
AM
PM
AM/PM
Date of Presentation (second choice)
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DD
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YYYY
Time of Presentation
HH
:
MM
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SS
AM
PM
AM/PM
Desired Length of Presentation
Type of Presentation
Classroom
Agency/Staff Meeting
Clinical Training
Other
Classroom Presentation: please list the class name and grade level
Number of Speakers Requested
1
2
3
Audience Size
Short description of audience knowledge level in lgbt issues
Additional info you would like us to know
Do Not Fill This Out