ACLU of South Carolina Speaker/Event Request Form

Speaker / Event Request Form
Date of Request*

MonthDayYear
Date
Contact Information
Name*

First NameLast Name
Organization*
Email*
example@example.com
Phone Number*
Event Details
Event Name
Event Description
Event Type*

Speaking Engagement - KeynoteSpeaking Engagement - PanelistSpeaking Engagement - Short SpeechSpeaking Engagement - PresentationEvent - Table/Booth (Inside)Event - Table/Booth (Outside)PodcastInterview (Radio/TV)Zoom/Teams/WebinarKnow Your RightsOther
Is this a non-partisan event?*

YESNO
Is this event open to the public?*

YESNO
Is event attendance free?*

YESNO
Event Speaker, Topic, and Audience
Speaker Requested, if applicable
Speaker Focus
Topic Requested
Target Audience
Expected Number of Attendees
How long would you like us to speak/present? (minutes)
Event Logistics
Date of Event

YearMonthDay
Date
Is Date of Event flexible?*

YESNO
If yes, what is your preferred alternative date?

MonthDayYear
Date
Start Time of Event

Hour Minutes

AM/PM Option
End Time of Event

Hour Minutes

AM/PM Option
Location of Event

Location

Street Address

CityState / Province

Postal / Zip Code
Does the event location have audio/visual equipment?*

YESNO
Additional Comments:
Sign up for ACLU emails to keep informed and know when to act.*

YESNO
Thank you for your submission. We will be in touch within a week to confirm our participation.

NOTE: Submission of this form does not guarantee the ACLU of South Carolina will be able to accomodate your request, especially during the legislative session when our staff is actively engaged in advocating at the South Carolina State House.
Should be Empty:

Speaker / Event Request Form

Contact Information

Event Details

Event Speaker, Topic, and Audience

Event Logistics