Thank you for your request for an EBMUD speaker. Please allow 3 weeks advance notice. Items marked with an asterisk * are required. For any questions, please email email@example.comName of organization *Type of organization *School/CollegeCommunity GroupProfessional GroupOtherAddress of organization (Please include city, zip code) *Contact person *Contact phone number *Contact alternate phone number *Contact email address *Address of presentation (If different from contact address. Please include city and zip code)Speaker topic(s) *Requested date *Time of event *First alternate date *Time of event *Second alternate date *Time of event *Speech duration (How long would you like the speaker to speak? Including Q&A.) *Number in audience *Will a computer projector and screen be available *YesNoWill a computer be available *YesNoComments / Other information (eg: parking, or other pertinent information) Processing The data has been submitted.