Speaker Request Form

Complete the form below to request a speaker for your event.

Please allow at least 2 weeks notice.

Group Information

Name of Group:

If your group is not listed in the menu, please list it below:

Contact Information

Contact Name *

Contact Email *

By providing your email address, you agree to receive emails from NH LAKES.

Contact Phone *

My role with the group is:

If other, please list here:

Contact Name on Day of Event/Meeting (if different):

Day of Event/Meeting Contact Phone:

Event Information

Type of Event/Meeting:

Annual Meeting

Monthly Meeting

Special Event

Other

Name of Event:

Date of Meeting/Event:

Time of Meeting/Event:

How many attendees are you expecting?

Is your event open to the public?

Yes

No

Website of Event:

Brief description of your event:

Event Location

Facility Name:

Type of Facility (indoor/outdoor/etc.)

Is wireless internet available for use?

Yes

No

Address Location of the Meeting:

City

State

Zip

Approximate driving time from Concord, NH:

Driving directions to event location from Concord NH:

Presentation Information

Time Slot or Length of Time you would like speaker to present:

Topics you would like speaker to discuss:

Invasive species

Water quality

Lake friendly landscaping

Advocacy

Membership recruitment

Fundraising

Boating concerns

Other

Please elaborate below:

Format you would like speaker to present (verbal presentation, Power Point, etc.)

If Power Point presentation is requested, what equipment will be provided? (check all that apply)

laptop

projector

screen (or light colored blank wall)

Note: NH LAKES staff may not be available to attend all events. This form is a request only, and is no guarantee that your event will be listed on the calendar or that a staff member will attend your event. If you requested a staff member to attend your event, you will receive an email confirming their attendance.