Speaker's Bureau Registration

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SPEAKER'S BUREAU
Registration Form

For assistance with the form check the Frequently Asked Questions

Topic:
Presentation Title
Brief Description (including any program preview file. See FAQ for procedure)
Presentation Length	(hours)
Availability
Travel Radius: (miles)
Equipment or Special Needs:

Presenter:

Name:
Address:
City:
State:
Zip:
Phone:	Home:	nnn-nnn-nnnn
	Business:
	Cellular:
Email:

Submitted by:		Same as above
Name:
Certificate No.
Address:
City:
State:
Zip:
Phone:	Home:	nnn-nnn-nnnn
	Business:
	Cellular:
Email:
Squadron:
District:

Comments to the Committee:

Speakers Bureau Chairman
Stf/C Steven L. Johnson, AP
10801 Sunnymeade Place
Oklahoma City, OK 73120-3106
(H) 405-751-5759 (B) 405-820-2179
Email: scj2@flash.net

Note: If a reply is not received within 5 working days after submittal,
please contact the chairman or resubmit.

Squadron Activities Committee

Squadron Activities
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