2. So we may best serve you, we ask that your request be a minimum of two weeks before your event. We look forward to speaking to your community or civic group.
4. Your Name*
6. Address
8. Phone Number*
9. Email*
11. Name of organization for whom you are requesting a speaker.*
13. Briefly state the organization's mission, goals or purpose.*
15. Event for which you are requesting a speaker.*
17. Address of Meeting/Event*
19. City *
20. State*
21. Zip*
23. Number of People Expected to Attend*
24. Date and time for which you are requesting a speaker.*
    Date and time for which you are requesting a speaker.

    Date and time for which you are requesting a speaker.
26. Topic You Are Requesting for Meeting/Event*
    -- Select One --Kids Just Want to Have Fun: Parks and Recreation Opportunities for Children and YouthChange the Way You Age: Parks and Recreation Opportunities for Seniors 60 and BetterHealth and Wellness: An Overview of Recreation Programs and Leisure OpportunitiesKeep Your Park Safe: Working with Park PoliceShare Your Time, Skills, and Talents: Volunteer Opportunities in Parks and Recreation
28. Preferred Length of Time for Presentation*
    -- Select One --30 minutes45 minutes1 hourOther
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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