Speakers Bureau Request Form

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Please complete this form, and a J Street staff member will be in touch shortly.

First Name *

Last Name *

Email *

Name of Organization/Synagogue *

Your Role/Title at Organization/Synagogue *

City *

State *

Preferred Event Date and Time *

YYYY

Time

Are Event Date and Time Flexible? *

Yes, both are flexible

Only date is flexible

Only time is flexible

Approximate Number of Event Attendees *

Preferred Speaker *

Please share a few sentences describing the type of event

What are goals of the event? What should attendees take away?

How did you hear about the J Street Speakers Bureau?

J Street staff

J Street leader/supporter

J Street website

Other:

Clear selection

Is there anything else you would like us to know?

Submit

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