JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Request a Speaker
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Group Requesting Speaker
*
Your answer
How many people will be attending?
*
Your answer
What date do you want the speaker?
*
MM
/
DD
/
YYYY
What time is your meeting?
*
Time
:
AM
PM
How much time is set aside for the presentation?
*
Your answer
What topic do you want the speaker to talk about?
Your answer
Do PowerPoint presentations generally work well in your meeting environment?
Yes
No
Clear selection
Do you have a laptop computer and projector available for use at the meeting?
Yes
No
Clear selection
Has your group had a presentation about the Port before?
Yes
No
Clear selection
Meeting Location
*
Your answer
Contact Name
*
Your answer
Contact Phone
*
Your answer
Contact Email
*
Your answer
Hod did you find out about our public speaker program?
*
CDRPA Website
Email
Word of Mouth
Other:
Required
Additional Comments
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
