Speaker Request - My Sister's House

I would like a speaker on:

Name

First Last

Name of organization:

Telephone Number:*

Email

Street address:

City

State

Zip Code:

I am seeking a speaker for:*

Please complete if you know details already. . .or someone from My Sister's House will follow up with you:

Name of host group/event:

Potential Dates:

Approximate time of day

Length of speech/training :

Location:

Audience Composed of (e.g., social workers, students, community members):

Approx. Audience size:

If the presentation will address domestic violence, please describe the audience's level of knowledge about domestic violence:

If the presentation will address sexual assault, please describe the audience's level of knowledge about sexual assault:

If the presentation will address human trafficking, please describe the audience's level of knowledge about human trafficking

Phone

This field is for validation purposes and should be left unchanged.