Request speaker :: East Bay Municipal Utility District

Name of organization *

Type of organization *

Address of organization *

(Please include city, zip code)

Contact person *

Contact phone number *

Contact alternate phone number *

Contact email address *

Address of presentation

(If different from contact address. Please include city and zip code)

Speaker topic(s) *

Requested date *

Time of event *

First alternate date *

Time of event *

Second alternate date *

Time of event *

Speech duration *

(How long would you like the speaker to speak? Including Q&A.)

Number in audience *

Will a computer projector and screen be available? *

Yes No

Will a computer be available? *

Yes No

Comments / Other information (eg: parking, or other pertinent information)