Speaker Request Contact Name: Name of Company or Event: Email Address Telephone Number: Mailing Address: Address: City: State: Zip: Event Details Speaking Topic: Date and Time of Event: Date: Time: Event Location (City, State, and Venue): City: State: Venue: Length of Presentation time Multiple Presentations needed? YesNo Audience Size Describe the audience. What do they do? What are their challenges? What do they want to learn/take away from this session? A/V equipment available? Will you film the event? (If so, a copy is requested ) YesNo Internet Access available? YesNo Is there a budget for this presentation? Is there a fundraising component to this event? YesNo What are the guidelines for travel budget and arrangements? Should I book the travel or will your company handle that? Onsite event contact name and cell phone number? Contact Name: Contact Phone Number: Donations to the 525 Foundation for Presentations are greatly appreciated. Compensation for time travel outside of St. Joseph County Indiana is requested. Inquires will be responded to within 7 business days.