NewsNet5.com - Sponsors

NewsChannel5 Speaker Request Form
NewsChannel5 speaker requested:
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 number:
E-mail:
Directions to event:
Please make sure all you contact information is correct. Incorrect information may delay your request