JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
FRRC Speaker Request
Please fill out this form to request an FRRC representative to speak at your next event. After receiving your request form, we will review it and determine the best speaker for your event.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Organization / Company:
*
Your answer
Tell us more about your organization.
We would like to know more about your organization whether it is your mission statement or link to your organizations info page.
Your answer
Date of event
*
MM
/
DD
/
YYYY
Name of Event
*
Your answer
Start and End time of the event (include time zone)
*
Your answer
Event Description (please include the narrative and objective)
*
Your answer
How will the speaker participate?
*
Keynote Speaker
One of Multiple Speakers
Panelist
Other:
{IF answered Panelist above} How many people expected on the Panel?
Your answer
How much time will the speaker have?
*
Your answer
What information would you like presented at your event?
*
Amendment 4
About FRRC
Criminal Justice Policy Reform
Required
If Desmond Meade is unavailable, are you open to having a representative of the organization speak?
*
No
Yes
Expected number of attendees
Your answer
Audience Demographic
*
Returning Citizens (formerly incarcerated persons)
Students or Young Adults
College or Graduate Students
Coalition Partners
Donors/Fundraisers
Directly Impacted (loved one who is a Returning Citizen)
Required
Will there be media present?
*
Yes
No
Maybe
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Florida Rights Restoration Coalition.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report