Free VA Form VA0879 - Speaker Request Form - Federal

SPEAKER REQUEST FORM
THE CENTER FOR WOMEN VETERANS (CWV) NOTE: Due to the volume of requests for speaking engagements, outreach and development, CWV asks that you complete the entire form below. Please note that six to eight months is most desirable to accommodate speaker calendar requests. Completion of this form will assist in expediting a timely response. If you have any additional inquiries, please contact CWV at (202) 273-6193 or visit us at : http://www.va.gov/womenvet.
SPEAKER REQUESTED DR. IRENE TROWELL-HARRIS, DIRECTOR BETTY MOSELEY-BROWN, ASSOCIATE DIRECTOR OTHER (Identify below)

HOST ORGANIZATION INFORMATION
NAME OF ORGANIZATION MAILING ADDRESS

POINT OF CONTACT

POSITION WITHIN ORGANIZATION

ORGANIZATION WEBSITE ADDRESS

E-MAIL ADDRESS

DAYTIME PHONE NUMBER

EVENING PHONE NUMBER

FAX NUMBER

EVENT LOGISTICS
NAME OF EVENT

DATE OF EVENT

TIME

VENUE LOCATION (Mailing address, venue room number, etcetera)

TYPE OF EVENT (e.g., Recognition Ceremony, Luncheon, Health fair, etcetera)

TYPE OF SPEECH (e.g., Keynote, panel participant, lecture, etcetera)

SPEAKING POINTS (Please include event theme and purpose)

AUDIENCE INFORMATION
TYPE OF AUDIENCE (e.g. women veterans, military, civic organization, public/private sector, etcetera)

EXPECTED NUMBER OF ATTENDEES

SPECIAL GUEST ATTENDEE(S)

VA FORM SEP 2006

0879

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