Speakers Bureau Request Form

Contact Name*

School / Organization Name*

Address (Location of speaking engagement)*

City, State*

Zip Code*

County*

Phone*

Ext

Cell Phone*

Your Email*

HHC Mailing List:

I would like to join the HHC mailing list.

Group Information

School District

School Category

PublicPrivateCharterHome SchoolParochial

Grade Level:

Audience Size:*

Audience Age*:

How does this speaker fit into your group's event?*

Please select the presentation type:*

Holocaust survivor and eyewitness testimonyPresentation about Holocaust history

NOTE: If you selected "Presentation about Holocaust history," please specify topic below.

Presentation Date

Choose a date and time preference below for the speaker's presentation. Requests should be submitted at least two weeks before the presentation date. Please check with your administration and school/activity calendar before submitting dates. We allow one reschedule for weather related cases. Presentations are typically 45 minutes and include: 1/2 hour presentation and 15 minutes of questions from the audience. Please note that speakers will arrive 15-30 minutes prior to his/her scheduled presentation time.

DATE:

Presentation Time:*

Please choose the time you would like the speaker to begin speaking.

Please choose the time you would like the speaker to stop speaking.

Speaker Needs*

Members of the Speakers Bureau have accompanying PowerPoint presentations which include additional photos and information that further illustrate his/her story. I am able to provide:

SpeakersProjectorComputerScreenMicrophone (upon request)I cannot provide technology

Speakers Bureau Donation

HHC requests a $100 donation for Speakers Bureau presentations. If your school/organization is more than 20 miles from our offices, we ask that you reimburse the speaker's travel expenses also. If your group needs assistance with the donation, please contact the Holocaust & Humanity Center directly at 513-487-3055.

Payment Method:*

Please do not give the donation to the speaker. Please send the donation directly to the Holocaust & Humanity Center. Please check the method of payment below. If you would like to pay with a credit card, please contact HHC at 513-487-3055.

CashCheckPurchase Order

How did you hear about the Holocaust & Humanity Center?*

News StoryEmailWebsiteMailingWord of MouthSearch EngineOther (please clarify below)

Signature Confirmation

In order for your presentation to be scheduled, you must sign below. You will receive confirmation of your presentation time and date within five business days of submitting your form. Please note, your Speakers Bureau presentation is not scheduled until you receive either a phone call or email confirmation from HHC.

• HHC cannot guarantee a specific speaker to present to your group.
• HHC is not responsible for changes in the speaker’s schedule. If a presentation is canceled, HHC will work with you to organize another presentation.
• Groups hosting the speaker will provide the speaker’s technology needs and a bottle of water.
• One week prior to the presentation date, please send arrival, parking, and check in instructions the speaker may need when entering the building and connecting with the contact.
• A cell phone number for the contact person must be provided.
• Contact person will coordinate for an escort to meet speaker upon his/her arrival.
• Please alert HHC if you plan to video the speaker’s presentation.
• Please reference that the speaker is part of the Nancy & David Wolf Holocaust & Humanity Center's Coppel Speakers Bureau in your marketing materials.

I have read and understand the regulations and procedures for a Speakers Bureau presentation. Please sign electronically below:*

Once this form has been submitted, you will see a green box confirming that the form was submitted successfully. For a pdf copy of this form please contact HHC.

For any questions contact the Holocaust & Humanity Center at (513) 487-3055.