Holocaust and Human Rights Education Center


Second/Third Generation Speaker Request Form

Please fill out this form with as much detail as possible. You will be contacted by Marie Riemerschmid, Director of Speakers Bureau. Due to high demand during Yom Hashoah (Day of Remembrance, April/May), we ask that you request a speaker at least 60 days in advance.

REQUESTOR'S CONTACT INFORMATION
First Name *
Last Name *
Name of Organization
Phone *
Email *

EVENT INFORMATION
Date of Event *	// (mm/dd/yyyy)
Start Time
End Time
Anticipated Age & Size of Audience

Location Name *
Street *
City *
State *
Zip *

Any other information we should know?

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