Speaker's Bureau Scheduled Event Request Form
Welcome! This form is to request a VCNJ Speaker for an upcoming event or group meeting
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Organization Name *
Contact Person *
Your name or name of a designated organization leader we should follow up with.
Contact Email *
Contact Phone Number *
What type of event is this? *
If in person, where?
Date Requested
If known. If you're unsure which date you'd like us to speak, we will reach out and work with you on a plan.
MM
/
DD
/
YYYY
Time Requested
If known. If you're unsure when you'd like us to speak, we will reach out and work with you on a plan.
Time
:
Anything else you'd like to tell us?
Submit
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