Charity Speaker Availability Form

General Information
Organization :
Speaker Contact :
Speaker Title :
Address :
City :
State :
Zip :
Phone :
Email :

What type of speakers can you provide?
Informative staff/volunteers Recipient of Services	Spanish Speaking Sign Language Interpreter

Please indicate timeframes in which you can provide speakers, checking YES, NO, or MAYBE below. (Several Postal locations, in particular, are 24 hour facilities. If willing, you could be called for a midnight agency fair or 4 am presentation. This will give you great exposure to these audiences, but if you know you can never participate at "off hours", please mark no. Thanks!)
9am — 5pm Yes No Maybe 5pm — 10pm Yes No Maybe 10pm — 9am Yes No Maybe Available on: Mon - Fri Saturdays Sundays
Other Available Timeframes:

How would you describe your presentation style? (Please check all that apply)
Humorous Serious Informational	Inspirational "Feel-Good"

In what counties do you offer services? (Please check all that apply)
In Collin In Cook In Dallas In Denton In Ellis In Fannin In Grayson In Henderson In Hunt	In Johnson In Kaufman In Navarro In Parker In Rains In Rockwall In Tarrant In Vanzandt In Wise

Can your organization provide agency tours?
Yes # of persons you can accommodate
No

Can your organization provide meeting space for training or special events?
Yes # of persons you can accommodate
No

Is your organization interested in participating in a "Days of Caring" activity and/or tours in early-mid September?
Yes No
What other types of services does your agency provide?	Briefly describe your main presentation or state why you might have special appeal to federal/state/city employees.

Charity Speaker Availability Form

General Information