American Gold Star Mothers, Dept of NJ - Speaker/Attendee Request Form

Speaker/Attendance Request Form American Gold Star Mothers, Department of New Jersey
Are You Requesting a Speaker/Keynote From The American Gold Star Mothers, Department of NJ Organization?*

YesNo
If Yes, Who Are You Requesting as Speaker/Keynote From American Gold Star Mothers, Department of NJ?*

Department of NJ PresidentDepartment Officer
If No Speaker Requested, Who are You Inviting to Attend From American Gold Star Mothers, Dept of NJ? (Check All That Apply)

Department Of NJ PresidentDepartment OfficersAll Department Members (Gold Star Mothers)Associate Members (Gold Star Family Members)
Maximum Number of American Gold Star Mothers and/or Associate Members You Would Like To Attend This Event*
Name of Requesting Organization/Company?
Organization Website Address?
Is Requesting Organization a Non Profit?*

YesNo
Point of Contact Name*

First NameLast Name
Contact Email*
example@example.com
Contact Phone Number

Area CodePhone Number
Name of Event or Conference*
Date Of Event

MonthDayYear
Date
Start Time Of Event

:HourMinutesAM/PM Option
End Time Of Event

:HourMinutesAM/PM Option
Event Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Theme(s) and/or Type of Event
Topic/Highlights You Would Like Included in Speaking Portion (If Applicable)
Please Provide a List of Other Speakers Invited. Include, Name, Title and Organization
Expected Number of Attendees In Addition To American Gold Star Mothers, NJ?*
Will Meal(s) Be Provided at This Event*

Yes, IncludedNo, Not AvailableYes, For Purchase
Will Parking Be Available at Event?*

Yes, Free Parking AvailableNo Parking AvailableYes, Parking Available For A FeeVIP Designated Parking Provided By Requesting Organization
Will Overnight Accommodations be Provided to Speaker/Attendees? (Only respond if Travel time to and from event exceeds three hours each way and/or length of event exceeds eight hours).*

Yes, Overnight Accommodations will be provided if applicableNot Available for this event
Will There Be a Resource Table Available for American Gold Star Mothers, Department of New Jersey if Requested?*

YesNo
Additional Relevant Information or Requests
Will A Donation Be Made To Our Organization - American Gold Star Mothers, Dept of New Jersey At This Event?*

YesNo
Please Note: All requests will be reviewed and honored based on availability of Dept President/Officers or members for the specific date and times listed. Someone from our Board will get in touch with you as soon as possible.

Thank you for contacting our orgainzation and all you do to honor our fallen heroes.
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Speaker/Attendance Request Form American Gold Star Mothers, Department of New Jersey