Guest Speaker Request Form

Requesting Organization

Name of Your Organization:*

Name of Contact Person:*

Phone:*

Email:*

Event Details

Date of Event:*

Location:*

Purpose of Event:*

Goal for WE ARE VB Participation:*
Community AwarenessFundraisingOutreach to School ProfessionalsOutreach/Support Directly for Students
Please Explain Your Goals/Expectations for This Event:*

Speaker Expectations

Arrival Time at Event:*

Duration of Speaking Time:*

Focus of the Speaker’s Comments:*

Please List Any Multimedia/AV Expectations for Our Speaker:*

Promotion or Logistical Expectations/Requirements

Logistical expectations:*
WE ARE VB Banner6 foot table(s)WE ARE VB HandoutsAdditional WE ARE VB Manpower
Expected WE ARE VB Promotion:*
FacebookInstagramConstant Contact/Email
If not listed above, please enter here:*

Please Provide Any Other Relevant Information:*