Speaker Request

Sponsoring Organization

Type of Organization

Contact Name

Contact Phone

Contact Email

Website

Date of Program

Time of Program

Name of Program

Theme/Purpose of Program

Location of Program

Proposed Topic

Presentation Format (panel, speech, roundtable, tabling, etc.)

Length of Speaker's Presentation

Size of Audience

Audience Composition (consumers, stakeholders, employers, other)

Language Needs

Please attach an agenda for your event.

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