CenterEdge Speaker Information

1. Name 
2. Address                                         
3. Phone                                                               Fax

4.      Email

5.      Background. Briefly describe your professional and/or volunteer experience as it relates to your involvement with CenterEdge. (Use back of sheet if necessary.)

6.      Preferred audience. (Check all that apply.)

Business       Environmental       Minority       Religious       Social Justice       Student

7.      Other (describe)

8.      Availability. (Check all that apply.)

Weekdays         Weekday evenings         Weekends

9.      Would you be interested in receiving training as a CenterEdge speaker?

Yes         No

10.  Do you need CenterEdge to provide you with equipment such as a laptop computer or             projector?

Yes         No

11.  7. Do you have any other preferences or requirements concerning being a CenterEdge speaker?             (Use back of sheet if necessary.)

Home      CenterEdge