Book a speaker

First name:

Last name:

Street Address:

City, state, zip:

Daytime phone number:

E-mail address, if applicable:

Organization name:

Preferred topics. List of sample topics.

Speech date:

Speech time:

Location of event (Please include any building name if applicable, street address, city, state and zip code.)

Approximate size of audience:

Desired length of speech:

Is audio/visual equipment available? (Please check all that apply.)

Slide projector

Overhead projector

Computer with internet connection

Slide Screen

Will the speech be open to the public?

Yes

No

Directions/Special instructions:

Questions? Write to mary-kenyon@uiowa.edu