RODGERS CENTER > Request for Speaker

 The Rodgers Center for Holocaust Education
   

Request for Holocaust Survivor-Speaker

GROUP INFORMATION: 
Name of Group or School:
Address:
   
Type of audience:
(check all that apply)		 Students Educators Senior Citizens
Business Other
If a student lecture, please specify which grade levels will be attending:
Number of people attending lecture:
   
CONTACT INFORMATION: 
Name:
Phone number:
Email:
   
LECTURE INFORMATION: 
Date:
Time:
Length of talk (including Q&A):
   
If necessary, can transportation be provided for the speaker to/from the location of the speaking engagement?
Yes No
If this is a lunch or dinner meeting, will a meal be provided for the speaker either before or after the lecture?
 Yes No
Will speaker receive an honorarium? Yes No
Additional comments about the lecture, lecture space or needs of the audience:
   
 
©2007 Chapman University • One University Drive, Orange, CA 92866   Phone: 714-997-6815
Website Powered by ActiveCampus™ Software