JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Women’s History in Montgomery County
Please use this form to request a speaker. If you have any questions, please contact the Speakers Bureau Coordinator at SpeakersBureau@MontgomeryHistory.org or 301-340-2825.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Requesting Group or Venue
*
Your answer
Date of Event
*
MM
/
DD
/
YYYY
Time of Event
*
Time
:
AM
PM
Name of Contact
*
Please provide your name
Your answer
Phone Number of Contact
*
please provide your phone number
Your answer
Location of Event or Meeting
*
Please provide a complete address or-if an online presentation-which platform will be used
Your answer
Location Phone Number
please provide the phone number of the venue where the event will take place
Your answer
Is this a public event?
*
Yes
No
Anticipated Audience Size
Your answer
Requested Presentation
Please select a presentation from the list below. If you are unsure of which program you want, select other or contact the Speakers Bureau Coordinator at SpeakersBureau@MontgomeryHistory.org or 301-340-2825.
Requested Presentation or Presenter
*
The Better Angels: Five women who changed – and were changed by – the American Civil War with Robert Plumb
Divided Nation, Divided Town: One Woman’s Experience with Emily Correll
Differing Historical Perspectives on Slavery in Maryland and the District of Columbia with James H. Johnston
Other:
Required
Special Requests
Please enter any special requests or needs related to your event here (optional)
Your answer
If you have any questions, please contact the Speakers Bureau Coordinator at SpeakersBureau@MontgomeryHistory.org or 301-340-2825.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
