North Texas Food Bank

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Speaker Request Form

Thank you for your interest in learning more about the North Texas Food Bank. Please fill out the information below and a staff member will contact you to make arrangements. View a list of our available Speakers.

Date of Event:
/ /
month / day / year ex: 1/5/07

Contact Person First Name:

Last Name:

Office / Home phone number:

Email Address:

Name of Event and/or Group:

Audience Type:
	Adults
	Children
	Mixed

Time the event begins:

Time the event ends:

Time the presentation is scheduled to begin:

Time the speaker needs to arrive:

Desired length of time for presentation:

Location of event:

Address of event:

Will your group provide the A/V equipment?
Yes No

Anticipated size of audience:

Desired topic:
What would you like to accomplish or emphasize in this presentation?:

In addition to a presentation, would you be interested in any of the following?
		NTFB Video (7 minute DVD)
		Brochures
		Fact Sheets
		Volunteer opportunities

Special instructions, requests or additional comments:

*Please type in the letters shown in the image below:

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Thank you for your commitment to those who are hungry in North Texas.