JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
NWHM Speakers Bureau Request
To schedule a virtual NWHM Women's History Connections Lecture or to receive further information about the program, please complete the form below. Thank you for your interest and for supporting women's history!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your Name:
*
Your answer
Host Organization:
Your answer
Name of Event:
Your answer
I am Interested in Speakers On the Following Topics:
*
Your answer
I am Interested in a Specific NWHM Speakers Bureau Lecturer (please list below) and Would Like to Inquire about Availability (multiple names acceptable):
Your answer
I Have a Specific Date in Mind, mm/dd/yyyy (please leave blank if date is flexible):
MM
/
DD
/
YYYY
I Would Like to Schedule a Speaker During this Month (check all that apply):
January
February
March
April
May
June
July
August
September
October
November
December
Time of Event:
Time
:
AM
PM
Audience Size:
Your answer
Describe the Audience:
*
Your answer
Will the Event be Recorded?
*
Yes
No
Contact Name and Address to be Invoiced:
*
Your answer
Let's Keep In Touch! Please Add My Email Address Listed Above to the Museum's Monthly E-Newsletter List.
Yes
No
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
