Speaker's Bureau Request Form
To request a speaker for your class, organization or event, please complete and submit this form.
Full Name
*
First Name
Last Name
Class, Event and/or Organization
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
Phone Number
*
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Area Code
Phone Number
Date of Event - -First Choice
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Day
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Month
Year
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AM/PM Option
Second Choice
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Year
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Third Choice
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Day
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Year
Date
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AM/PM Option
Length of presentation desired
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Presentation
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Include length of presentation, location, directions
Special Requests
*
Include your first, second and third choice of speakers
Projected Number of Attendees
*
Additional Message:
Questions filling out this form? Please contact Stephanie Hammerly, WALSAA Membership and Events Coordinator at 608-438-1994 or admin@walsaa.org.
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