Speaker Form

Club Information

Club Information » Speaker Form

Speaker Form

Please complete and submit one month prior to date of presentation for use by the Public Relations Committee and for our Website presentation.

Thank you!

Speaker Name:

Speaker Email:

Club Member coordinating presentation:

Date of presentation:

Title of presentation:

Brief Description of Presentation (to be used on website):

Website link for additional information on presentation/presenter:

Please Attach a digital photo to be used for “calendar of event” section on the website:

Technology needs or other requests for presentation (NOTE: Please advise speaker they will have approximately 20 minutes to present.):

Speaker's Employer/Organization and Job Title/Role:

Is the speaker a Rotarian?

What Club?

I grant permission to be photographed, recorded by video or audio tape, and/or otherwise pictured or quoted for any purpose related to development, marketing or any type of promotion or communication associated with the Early Bird Rotary Club of Sheboygan

Early Bird - Rotary Club

Club Information

Speaker Form