Holocaust and Human Rights Education Center


Second/Third Generation Speaker Request Form

Please fill out this form with as much detail as possible. If your school/business blocks outside emails, please offer an alternative email. You will be contacted soon regarding your inquiry. 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
Position
Second/Third Generation Speaker Name Requested
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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