Request for Speaking Engagements

Name of event *

Event type *

Other event type

Program sponsor *

Date and time of event *

Event venue/address *

Estimated audience size *

Describe the intended audience *

Is the event open to the public? *

Yes

No

Requested issue areas/subject: (check all that apply) *

Know Your Rights - please specify

Other - please explain

Will news media be invited to attend? *

Yes

No

If yes, please specify:

Other principals attending

How will the event be publicized?

ACLU-VA requested to help with publicity?

Yes

No

Will event sponsor assist with costs? (e.g., provide honorarium or reimburse expenses) *