Speaker Request Form Please submit your request two weeks prior to your scheduled presentation(s).Company name:*Address* Street Address Address Line 2 City Contact name:*Contact email:* Contact phone:*Today's date: Date Format: MM slash DD slash YYYY Suggested agenda for meeting: Welcome/CEO Campaign Endorsement United Way video United Way speaker Wrap-up Presentation Information:Date* Date Format: MM slash DD slash YYYY Time* : HH MM AM PM Meeting location*Estimated attendance*Speaker time limit:*Additional meetings: If you need a speaker for multiple similar meetings, please indicate the dates, times and details below. We would ask that you fill out separate Speaker Requests for different locations.Does the meeting location have capabilities to show the United Way campaign video during the presentation (about 3 minutes long)? Yes, we plan to show it from the internet. We will be showing a different UW video. No. If different, what UW video will be shown?Will this presentation be part of a company meeting covering other topics?YesNoIf Yes, what type of meeting is it?Audience Gender:Employee type:Average age range:Please tell us about any concerns or areas of interest you or the audience may have regarding United Way:Directions to the location (please include parking, entrance, sign-in, and any safety procedures):*Who should the speaker check in with upon arrival?*Please provide the name and phone number of someone the speaker can call at the time of the meeting if they would encounter an issue or need further directions.*Thank you for using a United Way speaker for your company campaign! You should receive confirmation of your request within 3 business days. If you do not, please contact us at 715-848-2927.NameThis field is for validation purposes and should be left unchanged.