LFUC Human Rights Commission
Speakers Bureau Application

If you would like to be considered as a speaker for the Speakers Bureau, please complete the information requested below after reading the criteria. Please insert your curser in the first grayed area and begin typing. Tab to complete all sections.  PLEASE NOTE: Pressing Enter will submit the form.

 

Mr.   Ms.  
                            Name Title
Company/Organization Address
City State Zip Code
Telephone Number Fax Number Cell Phone Number
E-Mail Address Web Site Address
Alternate Contact Name (Assistant's Info.) Telephone E-Mail Address
Yes     No
Principle Line of Business Do you have liability insurance?
Why do you want to participate in the Speakers Bureau?
What Organizations/Groups have you presented to?
Presentation Topic(s)/Title(s)
Yes     No
Presentation Style Length of Presentation Can length be adapted?
Preferred audience size Media Requirements
Expected objectives of presentation? What is your availability?
 
Are you available for media contact should the occasion arise? Yes     No

 

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Last modified: 06 May 2010