Speaker and Event Request Form

Name of Event *

Event Type

If "Other" - Describe The Event

Program Sponsor *

Date of Event *

Month

Day

Year

Time of Event *

Hour

:

Minute

am

pm

Event Venue | Address *

Estimated Audience Size

Describe the intended audience

Is this event open to the public? *

yes

no

Requested Issue (Select All That Apply)

Is there a specific staff member you have in mind (write "no" if not)

Will media be invited to attend? *

yes

no

If yes, please specify

How will the event be publicized?

Is the ACLU of Alabama requested to help with publicity?

yes

no

Will the event sponsor assist with costs? (For example, provide honorarium or reimburse expenses?) *