Request a Speaker Event Information Event/Group Name * Type of Event * In person Virtual Address of Event If In Person Event Date * - Month - Day Year Date Picker Icon Event Start Time * 1 2 3 4 5 6 7 8 9 10 11 12 : Hour 00 10 20 30 40 50 Minutes AM PM AM/PM Option Event End Time 1 2 3 4 5 6 7 8 9 10 11 12 : Hour 00 10 20 30 40 50 Minutes AM PM AM/PM Option Anticipated Audience Size * Audience Type Adults Children Both Brief Audience Description * Speaker Prep Information Approximate NTFB Presentation Time 1 2 3 4 5 6 7 8 9 10 11 12 : Hour 00 10 20 30 40 50 Minutes AM PM AM/PM Option Presentation Length * What would you like to accomplish or emphasize in this presentation? * Will there be other speakers at the event? * Yes No Please describe the other speakers. In addition to a presentation, would you be interested in any of the following materials? NTFB Video (4 minute video) NTFB newsletter Volunteer opportunities Will you have audio/visual equipment available for use at the event? Yes, we will have audio/visual equipment available No, we will not have audio/visual equipment available Special instructions, requests or additional comments Contact Person Information Full Name * First Name Last Name Email Address * Phone Number * - Area Code Phone Number Additional Phone Number - Area Code Phone Number How are you familiar with NTFB? * * Required fields SEND Should be Empty:
