District 7 Toastmasters

Request A Speaker

Please be sure to read the Guidelines and Policies page before completing this application.

Bold text indicates required fields.

Group Information

Group Name:
Check all that apply:
Non-profit	Service	Civic	Religious
Fraternity/Sorority	School	Youth group
Professional	Government	Support Group

Special Interest:

Additional Comments:

Event Information

Theme/Topic:
Month:	Day: Year: Time:
Address 1:
Address 2:
City:		State:	Zipcode:
Audience Age:		Attire:
Size of Event:

Type of Event (check all that apply):
Group Meeting	Awards Ceremony	Dinner
Training/Seminar	School Assembly	Class
Equipment Available (check all that apply):
Microphone	Lectern	Podium
Overhead Projector	LCD Projector	Screen

Speech Information

Topic:

Type of Presentation (choose one):

Additional Comments:

Contact Information

Contact Name:
E-mail:
Phone:	FAX:
Address 1:
Address 2:
City:	State: Zipcode:

Questions? Suggestions?

The names "Toastmasters International", "Toastmasters", and the Toastmasters International emblem are trademarks protected in the United States, Canada, and other countries where Toastmasters Clubs exist. Unauthorized use is strictly prohibited.