Request a Speaker: The Speakers Network

Fair Wisconsin speakers draw from their diverse backgrounds and expertise. Please fill in the following fields to describe your organization and the type of event so that the we can find a speaker that is just right for you!

Organization/Group name:
Title:
Contact name:
Primary mode of contact:	Home Work Cell
Phone:
Fax:
Email:
Address:
City:
State:
Zip:

Event Information

Event Date:
Event start time:		:	am pm
Speaker start time:		Speaker end time:
:	am pm	:	am pm

Event Location:
City:
State:
Zip:
Expected Attendance:

Who is your intended audience? (members of LGBT community, staff of your organization, etc):
What type of event will this be? (panel, training, workshop):
What is the focus or mission of the group?
Are there specific questions you want addressed?
What is the deadline by which you will need us to respond?
Will other organizations or individuals be speaking? Opposition?
Will the media be invited?	yes no
Any additional comments:

Authorized and Paid for by Fair Wisconsin Committee, Michael Childers, Treasurer.