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District 3 Home Page | SPEAKERS BUREAU | |||||||||||||||||
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Speakers Bureau Application Please type/print and send
to: DEE DEES, DTM Speaker's application information will be included in a printed directory and distributed to civic, community, educational, governmental, and professional organizations in Arizona which frequently seek speakers for their programs and events. It is also posted on the Speakers Bureau web site at http ://www. angelfire.com/az/D3tmSpeakersBureau for the speakers who wish to be included. A photograph may also be submitted for the web page listing. Enclose a self-addressed stamped envelope if the photograph is to be returned. Please check all personal. By including it here, you are giving permission for it to be published in the directory. ___ Name ___ Address ___ Phone(H) ___ Phone(W) ___ E-Mail ___ Fax SIGNED _____________________________________________________ DATE__________________________________
Name _______________________________________________________ Club and Club #________________________________________________ Circle Applicable Level --CTM, ATM, ATM-S, ATM-G, DTM Address ______________________________________________________ City ___________________________State _______________ Zip ________ Telephone (H) ______________________ (W) ________________________ Occupation ____________________________________________________ Biography _____________________________________________________ _____________________________________________________________ _____________________________________________________________ Speech #1 ____________________________________________________ Title __________________________________________________________ Subject _______________________________________________________ Speaking Time ______________________ Description of Speech ____________________________________________ _____________________________________________________________ ______________________________________________________________ (Using the above Speech #1 format, please attach another page for additional speeches. The Speakers Bureau usually lists about three speeches)
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