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Speaker Request Form
Please submit your request
two weeks
prior to your scheduled presentation(s).
Today's Date
Company Name:
Street Address:
City:
Company Contact Person:
Company Contact Email:
Company Contact Phone:
Suggested agenda for meeting:
Welcome/CEO Campaign Endorsement
United Way video
United Way speaker
Wrap-up
Date & Time of Presentation:
Date & Time of Presentation:: Date
Date & Time of Presentation:: Time
Will this presentation be part of a company meeting covering other topics?
In Person
Virtual
Estimated Attendance:
Speaker Time Limit:
Additional Meetings:
Will this presentation be part of a company meeting covering other topics?
Yes
No
Employees in this presentation are: (check all that apply)
Leadership
Hourly Employees
Part-time/Seasonal Workers
New Employees
Hybrid/Remote
I Don't Know
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.
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