Request a Speaker

URL
This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
Date Submitted
Date of Event*
MM slash DD slash YYYY
Event Start Time*

: HH

MM

AM/PM
Event End Time*

: HH

MM

AM/PM
Request Type*
Topic of Interest*
Would you like a PowerPoint presentation*?
- Yes
- No
*Our volunteers can present either with or without PowerPoint. If you would like for us to display slides, you must provide a computer and projector as well as a person to operate them during the presentation.
Is there anything else we should know?
Name of Facility*
Address*
Street Address Address Line 2 City State ZIP Code
County*
Number of People Attending*
Contact Name*
First Last
Contact Phone Number*
Contact Email*

Upcoming Events:

May 27
10:00 am
to
4:00 pm

This event will include entertainment, brain health screening, education sessions, food, and giveaways.

May 28
10:00 am
to
12:00 pm

One2One is a free phone-based program that supports at-risk adults over 60 and people with disabilities in…

Get Email Updates

Eligibility, Costs, and Process