To request a speaker for your organization or group,
please print this form, fill it in, and mail to:
The Santa Clara Valley Chapter of the ACLU of Northern CA
P.O. Box 5303,
San Jose CA 95150
You and Your Organization:
Your Name: ____________________________________________
Daytime phone: ________________Evening phone: _____________
Organization Name: ______________________________________
Please specify the purpose of your organization:
______________________________________________________
______________________________________________________
Speaking Engagement Details: (At least 3
weeks advance notice.)
Preferred Date:___________________________________________
Alternative Date (1):____________Alternative Date (2):____________
Start Time:___________________Time Allotted For Speech:_______
Where the speaking engagement will be held:
Address:________________________________________________
_______________________________________________________
_______________________________________________________
The subject of the requested talk:
_______________________________________________________
_______________________________________________________
Who will introduce the speaker?
Name:__________________________________________________
Daytime phone: ________________Evening phone: _____________
Any additional questions or comments you may have:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Santa Clara Valley Chapter of the ACLU of Northern California, Inc.
www.acluscv.org . acluscv@hotmail.com . 408-327-9357 (voicemail only) P.O. Box 5303, San Jose CA 95150