Sacramento Returned Peace Corps Volunteers
Speakers' Bureau Registration Form



Name: _________________________________________________________________

Address: __________________________ City: ___________________ Zip:___________

Tel: (home) ________________ (work) ________________ Best time to contact: ______________

Email address: _____________________________________________________________

Title/Brief description of your work_____________________________________________________

Type of groups desired (schools, community, professional, etc.) ______________________________

Time available:                              Day of Week            Time
            Weekdays:

            Weeknights:

            Weekends:

Available on short notice? _____ Lead time needed: ______________________________

Country of Peace Corps Service: ________________________ Years: From ____To ____

Peace Corps Job Assignment: ________________________________________________

Language(s) spoken: __________________ Special skills: _________________________

Preferred topic(s) for presentations: ___________________________________________

________________________________________________________________________

Type of presentation (check all appropriate types):

      ___Discussion/lecture      ___Video      ___Artifacts      ___Slides/Tape       
       
      ___Power Point            ___Film      ___Music      ___Dance      ___Food      

      ___Language Lesson      ___Other_________________________________________

Equipment required of the organization/school: ________________________________________
 
______________________________________________________________________________



Additional Information or Comments: __________________________________________

________________________________________________________________________


Date: ___________________________