Requests for Speakers

Name of organization:

Contact Person:

Position:

Phone Number:

Email:

Person you are requesting:
Any one of the staff training teamA particular staff person:

Date of training (or approximate time of year):

Topic:

Length of presentation (hour, day(s)):

Location:

# of participants attending:

Knowledge level of participants:
introductoryintermediateadvanced

Description of audience:

Does your organization cover:
Honorarium. If yes, please indicate amount belowTraining FeesShipping and Handling Charges for Hand Outs & MaterialsTechnical SupportAirfareHotelMealsTransportation to and from airport/ any otherOther

Please indicate the amount and currency of honorarium your organization covers below: