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KJRH 2NEWS Speaker Request Form
KJRH 2NEWS speaker requested:
 
Please indicate a second speaker in case first choice is unavailable:
 
Please indicate a third speaker in case your first two choices are unavailable:
 
Name of requesting organization:
 
Please provide information about your organization:
 
Please give a brief description of your event:
 
Date of event:
 
Expected attendance:
 
Where will the event be held?
 
Time speaker should arrive at event:
 
How long is speaker needed?
 
List of duties to be performed: (ex: speech, award presentations, etc.)
 
Does your event currently have a TV/media partner? If so, which one?
 
Name of person making request:
 
Work number:
 
Fax:
 
Home/cell number:
 
E-mail:
 
Directions to event:
 
Please make sure all your contact information is correct.
Incorrect information may delay your request
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