Democrats for Change Speaker Request Form
Use this form to invite Lisa McCormick or request another Democrats for Change representative to your event.
Email address *
First name *
Last name *
Company/Organization
Title
Phone *
E-mail Address *
Organization or Event Website URL
Event Name *
Location (Venue Name) *
Location (Address, City, State, Zip) *
Event Start Date *
MM
/
DD
/
YYYY
Event Start Time *
Time
:
Event End Date *
MM
/
DD
/
YYYY
Event End Time *
Time
:
Requested Speaker
Surrogate speaker acceptable
Event Sponsors
Event Agenda
Invited Speakers
Confirmed Speakers
Audience Demographics
Number of Expected Attendees
Can you attend?
Clear selection
Is this time slot flexible and/or tentative?
Clear selection
Format of Event
Let us know what format
Q & A Included?
Clear selection
Are press invited?
Will session be recorded?
Is the public invited to attend?
Is there any other information you would like us to know to evaluate this request?
Submit
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