Give to LA - Speaker Request Form
2017 City of Los Angeles - Give to LA Combined Charitable Campaign
City Department: *
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Coordinator Name: *
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Phone: *
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FAX: *
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Email: *
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Location Address: *
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City *
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State *
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Zip *
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Date of Event *
MM
/
DD
/
YYYY
Number in Audience: *
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The Meeting Begins: *
IMPORTANT - Please indicate AM or PM
Time
:
The Meeting Ends: *
IMPORTANT - Please indicate AM or PM
Time
:
Length of Speaker's Presentation: *
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Type of Event: *
Site Contact Person: *
If different from "coordinator" listed above
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Phone: *
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FAX: *
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Location of Speaker Engagement: *
Indicate the specific location = room #, floor, conference room, department, building, etc...
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Where Speaker Checks In: *
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Where Speaker Parks *
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Requested Charities: *
Feel free to invite ALL charities, but please select at least 3 below
Required
Special Instructions: *
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Remember:
Our speakers are in demand - please allow 5 working days for scheduling.
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