Speaker Request Form

Submitted by cvanvalkenburg on Wed, 2008-10-15 05:51.


This application is the first step in setting up a Speakers Bureau event at your campus.

As you get started, make sure you have a copy of our Speaker Event Planning Checklist to help you plan your event.

The SSA's campus organizers are more than happy to help you with your event, and will be in touch as you plan your event to make sure things are progressing smoothly. In addition, you can also contact the campus organizer (organizer(AT)secularstudents(DOT)org) with any questions or concerns you have along the way.

Best of luck with your event!


Contact information for yourself:

Name:
E-mail:
Phone number:

Details about your group:

Group's Name:
School that your group is located at:
Group's E-mail:
Group's Street Address 1 (Optional):
Group's Street Address 2 (Optional):
Group's City:
Group's State/Province:
Group's Zip/Postal Code:
Group's Country:

Speaker Information:

Speaker Desired:
Topics interested in having the speaker talk about:
Dates that you are interested in having the speaker come to your school (a ballpark range is fine also):
If you are partnering with any other groups or individuals on this, please include those details here:
Do you expect that you will require Speakers Bureau funding assistance for this event? If so, how much? (Please note that this does not guarantee funding - we encourage groups to seek funding from all possible sources.)
Comments? Questions?:
Prove you are a human: what is two plus two?


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