Straight Talk! Speakers Bureau
Speaking Engagement Request Form

Name:
Today's date:
Phone:
Email:
Name of organization/department:

Date of engagement:
Time:
Location:
Is your request for:
Event/course name:
Anticipated audience size:
Description of event/course:
Are there any specific topics you would like us to address:

If this is a classroom presentation, please answer the following:
Will material concerning sexuality be covered in this class prior to the speaking engagement?
If so, briefly describe:
Will the class be informed in advance of the topic(s) of the speaking engagement?

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