Speakers Bureau

 
 
 

CCBC Speaker's Bureau Request Form

Important: Be sure to include a second and third choice of topic, should your first be unavailable.

  Organization name:
  Contact person:
  Daytime phone number:
  E-mail address:
  Street address where event/meeting will be held:
  
  Date of presentation:
  Time of presentation:
  Anticipated number of attendees:
  
  Topic/speaker requested
  Brief description of audience (e.g. seniors, office professionals, garden club, etc.)
  
 
 

 
 
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