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Children's Advocacy
Please fill out the following form to request a speaker at your upcoming group meeting.
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Event Information
Name Of Group
*
Date Of Event
*
Date Of Event Date
Date Of Event Hours
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
Date Of Event Minutes
00
05
10
15
20
25
30
35
40
45
50
55
Alternate Date
*
Alternate Date Date
Location
*
Number Of People Attending
*
What does your club/group do?
*
Will there be a TV/VCR available?
Will there be a meal provided for the speaker?
Name
Contact Name
*
Daytime phone number
*
Email Address
*
