Community Engagement Request
Thank you for your interest in having a Lighthouse representative give a presentation at your organization or special event. Please complete the following information and we will respond promptly. Due to our limited capacity, we ask an honorarium of $200 for a formal presentation from our expert attorneys. Thank you!

N.B. Please complete this form with the understanding that, due to the quantity of speaking engagement requests we receive, we are unable to commit to each and every request. Please complete this form as far in advance as possible to reserve your spot and give us time to prepare!
Email *
Name *
Email *
Phone Number *
Name of your institution (business, church, school, etc.) OR name of your event: *
How did you hear about LIA? *
Required
Location of community engagement: *
Please describe the audio/visual set-up that will be available at the location.
Date of community engagement: *
MM
/
DD
/
YYYY
Time of community engagement: (if unsure or flexible, please put your best estimation and specify this in the comments box at the end) *
Time
:
Which best describes the type of community engagement you are requesting? *
IF YOU CHOSE PRESENTATION: What topic(s) would you like the presentation to focus on?
Clear selection
IF YOU CHOSE SPEAKING ENGAGEMENT: Please say more about what you would like the speaker to share & what you would like the audience to hear about?
Who is the target audience and approximately how many people are estimated to attend? *
Please tell us anything else about the nature of the presentation you are hoping to have, any questions you might need answered, and if you have specific requests.
Please check the box to indicate that completion of this form does not guarantee a spot on our presentation schedules due to the number of requests we receive. *
Required
Please check the box to indicate that if we accept your request for a formal PRESENTATION, your organization is prepared to pay the $200 honorarium for our services. *
Required
Additional Questions/Comments
A copy of your responses will be emailed to the address you provided.
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