Speaker Request Form

Please submit your request two weeks prior to your scheduled presentation(s).

Company Name:

Company Contact Person:

Suggested agenda for meeting:

Welcome/CEO Campaign Endorsement
United Way video
United Way speaker
Wrap-up

Additional Meetings:

Please tell us about any concerns or areas of interest you or the audience may have regarding United Way:

Directions to the location (please include parking, entrance, sign-in, and any safety procedures):

Who should the speaker check in with upon arrival?

Please provide the name and phone number of someone the speaker can call at the time of the meeting if they would encounter an issue or need further directions.

Thank you for using a United Way speaker for your company campaign! You should receive confirmation of your request within 3 business days.

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