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 or developement professional with experience in bequests and/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)
Time for a LEAVE A LEGACY® speaker _____:______ to _____:_____ AM or PM
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 firstname.lastname@example.org . We will call you with a name of a LEAVE A LEGACY® CONNECTICUT speaker for your event.