Be'chol Lashon: Educational Resources: Speakers: Speakers Bureau Request Form

Speakers Bureau Request Form

General Information

Name of speaker you would like to request

If you don't have a particular speaker in mind, in what subject are you interested?

How did you learn about Bechol Lashon?

Event Information

Date of event (mm/dd/yyyy)

Event City:

Event State:

Event Country:

What is your budget range for speaker fees, travel and related expenses? Between $ and $

Event Venue:

Est. Start time:

Length of presentation (approx.)

Audience Size: (approx.)

Type of Events: (check all that apply)

Scholar-in-Residence Weekend
Shabbat Service
Lecture/Discussion
Sunday School
Music Performance/Concert
Music/Community Festival
Other (please explain)

What is the purpose of your event ?

Fundraising
Community Education
Other (please explain)

Please describe your event's theme or objective:

Who is your primary audience?

Please enter any additional comments or questions here:

Contact Information:

Name:

Email:

Phone:

Organization:

Title:

Street address:

City:

State/Province:

Zip/Postal code: Country:

Fax:

Please verify that you are making an authentic request by entering the words that you see below.

For more information email us at bechol_lashon@jewishresearch.org.
Or call us at 415-386-2604.

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