Speaker's Bureau Request

Speaker's Bureau Request

The Presbyterian Healthcare Speaker's Bureau can assist you in arranging a speaker to address your business, group or meeting. If you have any questions please contact us at 704-384-7507.

*Denotes required fields

*Contact Name:

(First, Middle Initial, Last)
*Organization:

*Work Phone:

- - Ext.
*Email Address:

*Requested Topic:

Program Dates:

* / / (MM/DD/YYYY)

/ / (MM/DD/YYYY)

/ / (MM/DD/YYYY)

Start Time

End Time
* Time:

Program Location:

*Address 1:

Address 2:

*City:

*State:

*Zip:
Type of Event:

Breakfast Fundraiser

Luncheon

Evening Fundraiser

Walk

In-Kind

Run

Other
*Expected Attendance:
*Age:  (Please check all that apply)    0-34     35-59     60-85     85+

*Race:  (Please check all that apply)   Asian      African-American/Black     Caucasian/White    Hispanic

Multi-Racial Native American Pacific Islander Other

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