Prospective Speakers Request Form

Hello and thank you for visiting our web site.

If you would like to speak at one of our upcoming programs, please fill out the contact form below.

Thank You, 

HRHS Programs Director

 
1 Start 2 Complete
Speaker Contact Information
Please provide your full name as you would like to have displayed on the promotions, brochures, eBlasts (Newsletter), event forms etc. If there are additional names you would like to include, Please include them in the additional information field.
Please provide us with a working phone number in the event that we need to contact you. As per our privacy polices, no information here will be shared outside of our organization. This phone number will be used in the event that we need to contact you in the event of an emergency. Please use the format XXX-XXX-XXXX
Please provide a working email address for us to contact you in the event that we need additional information for the program.
If you have a short self portrait, please feel free to upload it here. (Maximum size 10mb)
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd.
Speaker Subject Information
Please include a 40 character subject. This will be used in our promotional materials and web events.
Please give us a brief description of your speaker topic. Please indicate it's historical significance.
Feel free to upload a document containing your bio and or topic description.
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.