Agency Speaker or Tour Request FormAgency Speaker or Tour Request Form To be completed by the person that is making the request:Do you want to request a Speaker or a Tour?*SpeakerTourSpeaker RequestDate of presentation* Date Format: MM slash DD slash YYYY Time of presentation* : HH MM AMPMWorkplace requesting*Level*Purpose of presentation (committee/ECC training/presentation to employees, etc.)*Estimated number of people in audience*Address for presentation*Directions or instructions, (i.e. where to meet)Speaker, Agency or Impact Area Requested:Choice #1Choice #2Choice #3Staff/LR making request* Request approved by*Date of request* Date Format: MM slash DD slash YYYY Is the attending staff/LR the same as above?*YesNoWho is the attending staff/LR?* First Last Additional commentsTour RequestDate of Tour* Date Format: MM slash DD slash YYYY Start timeEnd timeWho is the custom tour for? (Workplace/Group)*How many people are expected to participate?*Request approved by* Date approved* Date Format: MM slash DD slash YYYY
TOP 
