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?* Speaker TourSpeaker RequestDate of presentation* MM slash DD slash YYYY Time of presentation* : Hours Minutes AMPM Workplace 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* MM slash DD slash YYYY Is the attending staff/LR the same as above?* Yes NoWho is the attending staff/LR?* First Last Additional commentsTour RequestDate of Tour* 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* MM slash DD slash YYYY
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