Cincinnati State / Speakers Bureau / Request a Speaker Request a Speaker Organization InformationOrganization Name* Organization Address* Street Address City State / Province / Region Contact InformationContact Name:* First Last Contact Position with Organization:* Contact Phone:*Contact Email Event InformationEvent Day of the Week:*Select…MondayTuesdayWednesdayThursdayFridaySaturdaySundayEvent Date:* MM slash DD slash YYYY Event Start Time:* : Hours Minutes AM PM AM/PM Event End Time:* : Hours Minutes AM PM AM/PM Event Address:* Street Address City State / Province / Region Event Description:* Speaker Requested (1st choice):* Topics (1st choice):* Speaker Requested (2nd choice): Topics (2nd choice): Estimated Audience Size:* Is your organization interested in a campus tour? Yes No Comments:PhoneThis field is for validation purposes and should be left unchanged.
