Speaker Request Form

Complete the form below to request a speaker for your event. Please allow at least 2 weeks notice.

Group Information

Name of Group:

If your group is not listed in the menu, please list it below:

Contact Information

Contact Name *

Contact Email *

Contact Phone *

My role with the group is:

If other, please list here:

Contact Name on Day of Event/Meeting (if different):

Day of Event/Meeting Contact Phone:

Event Information

Type of Event/Meeting:

Annual Meeting
Monthly Meeting
Special Event
Other

Name of Event:

Date of Meeting/Event:

Time of Meeting/Event:

How many attendees are you expecting?

Is your event open to the public?

Yes
No

Website of Event:

Brief description of your event:

Event Location

Facility Name:

Type of Facility (indoor/outdoor/etc.)

Address Location of the Meeting:

City

State

Zip

Approximate driving time from Concord, NH:

Driving directions to event location from Concord NH:

Presentation Information

Time Slot or Length of Time you would like speaker to present:

Topics you would like speaker to discuss:

Invasive species
Water quality
Lake friendly landscaping
Advocacy
Membership recruitment
Fundraising
Boating concerns
Other

Please elaborate below:

Format you would like speaker to present (verbal presentation, Power Point, etc.)

If Power Point presentation is requested, what equipment will be provided? (check all that apply)

laptop
projector
screen (or light colored blank wall)

Note: NH LAKES staff may not be available to attend all events. This form is a request only, and is no guarantee that your event will be listed on the calendar or that a staff member will attend your event. If you requested a staff member to attend your event, you will receive an email confirming their attendance.

Check the box please before submitting your form.

Timeout Warning

Speaker Request Form

Group Information

Contact Information

Event Information