Cupertino Rotary Speaker Form
If you are interested in being a featured speaker at our club, fill in the following information and someone from our club will be in touch.""Club policy prohibits speeches that are political or sales-oriented in nature."

Your name *
Your answer
Your Email *
Your answer
Your Phone number *
Your answer
Topic Title *
Your answer
Have you seen this speaker present? *
Speaker Name and Contact Information *
Your answer
Provide us a detailed description of the topic *
Your answer
Speaker Background/Bio *
Your answer
If available provide us a link to a website, YouTube or video that will help us better understand the presentation
Your answer
Is there a theme or ‘best time’ for this program (i.e., association with a holiday, known speaker availability):
Any other information you would like us to know? *
Your answer
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