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Speaker Request Form
LEAVE A LEGACY® volunteers are seeking to spread the word by making presentations to civic organizations across Connecticut. If you are affiliated with a civic organization and are planning an event, conference or meeting, please consider adding a LEAVE A LEGACY® speaker to your program. The speaker will be a professional advisor with experience in bequests or planned giving. The typical presentation is thirty minutes but can be altered to fit your program needs. q Yes, I am involved with a civic organization that is hosting an event. Name of organization _________________________________________________________________ Date of upcoming meeting or conference__________________________________ Location of meeting or conference_______________________________________ Audience: __Nonprofit Organization(s) __General Public ___Other (please specify) _________________________________________________________________ Program Title_______________________________________________________ Time for a LEAVE A LEGACY® speaker _____:______ to _____:_____ AM or PM Your name_________________________________________________________ Your title __________________________________________________________ Your address ______________________________________________________ Your phone/fax _____________________________________________________ Your email address_______________________________________________________ Thank you for helping to spread the word about LEAVE A LEGACY® Please fax or e-mail this form to (781) 647-7222 or pggct@camihq.com . We will call you with a name of LEAVE A LEGACY® CONNECTICUT speaker for your event. |