Speaker's Bureau Request Form
Thank you for your interest in having someone from the Cape Canaveral Lighthouse speak to your organization. We would be happy to present information about lighthouse activities and future plans to your group. If you'd like to learn more about the lighthouse, its unique relationship with the nation's space program, and what you'll see when you come visit, please complete this form. Someone will contact you within a few days to finalize the engagement.
Group's Name
*
Description of the Group's Purpose or Mission
*
Name
*
First Name
Last Name
Email
*
Confirmation Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Meeting Date
*
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Month
-
Day
Year
Date
Time
*
Hour Minutes
AM
PM
AM/PM Option
Meeting Location
*
Estimated Number of Attendees
*
Requested Length of Presentation
*
Audio/Visual Capability Available
*
Additional Helpful Information (optional)
*
Submit
Should be Empty: