Speaking Request Form

Name *

Name

First Name

Last Name

Email Address *

Event Title *

Brief Event Description *

Event Website

http://

Event Dates *

Event Dates

YYYY

Event Location *

Event Host *

Describe the intended audience/attendee (age, background) *

What day of the event will The ExceptionAL Project be presenting? *

What presenter expenses will you be paying? (Travel, hotel, meals, etc) *

What equipment is provided? (speakers, projector, microphone, etc.) *