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New Against All Odds Page

Speaker Request Form

 

 

Organization Name:__________________________________Website;________________________

 

Address___________________________________________City/State/Zip:____________________

 

Contact Name:___________________________________Department: ________________________

 

Contact Phone: _______________________Email:________________________________________

 

 

  1. Date of Event:______________ Time of Event:____________   Is the event date flexible?:_____

 

  1. Location of Event: _______________________________________ Seating Capacity:_________

 

  1. How many people are expected to attend the event?_____________

 

    1. Description of the audience? (at-risk youth, educators and/or child welfare professionals, genearl public)_____________________________________________________

    2. Age range?____________

    3. Gender?______________

    4. Do you have a specific targeted audience?___________________________

    5. Any other information that will be helpful?___________________________________________________________

 

  1. What is your budget for the speaker?________________

 

  1. Goal of event?________________________________________________________________

 

  1. Do you have a specific topic in mind?_____________________________________________

 

  1. What type of event is it? (Is this a lecture only or does it include luncheon, dinner, information fair, etc?)  Describe event as much as possible. ______________________________________

 

  1. Length of time of event:_________________________________________________________

 

    1. How long would you like speaker to present? _________________________________

 

  1. How will you publicize the event?

    1. Do you have a newsletter/brochure? Yes / No.  If so, how many households does the newsletter reach?___________

    2. Email broadcast?  Yes / No.  If so, how many people does the broadcast reach?________

    3. Flyers?  Yes / No.  If so, where will the flyers be displayed?_______________________

    4. Direct Mail?  Yes/No.  If so, how many households will it reach?_____________

    5. Will you advertise the event?  Yes / No    Where?________________________________

 

 


__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

*Requests must be made at least 72 hours in advance and subject to speaker availability

 Return this form via fax to 908-206-9810 or via email: hr@againstalloddsfoundation.com