Speaker Request Form for Leadership Employee Audience

Speaker Request Form for Executives, Management, and/or Potential Leadership Givers ($1200+, $800+ for under age 40, $500+ for under age 30)

A local business executive, partner agency executive and/or United Way volunteer will share their own story about how they, their company and/or agency benefits from the relationship they have with United Way and the impact that Leadership giving plays in making UW successful. A United Way representative will always accompany the speaker(s) in order to give an overview of United Way (if time allows) and answer any questions that may arise. Each speaker will speak for 5 minutes unless otherwise instructed by the company.

Complete one form for each time and date a speaker is needed. Please submit your request 15 business days before your meeting date.

Information about the Company/Organization requesting the speaker:
Submitted by*   A value is required.
Today's Date  
Company/ Organization Name*   A value is required.
Telephone*   A value is required.
Cell phone (for contact day of meeting)  
E-mail  
Alternative Company Contact Name  
Alternative Company Contact Email  
Physical Address*  
United Way Staff Contact or your Campaign Associate:  
United Way Staff or Campaign Associate Cell Phone:  
Meeting information:
 
Date*  
Time*:   AM PM
  minutes early
  Yes No


In order for the speaker to better prepare their speech, please tell us a little about the audience:
 
 
Average Age Range of audience:  
% Male  
% Female  

Please choose which type of speaker(s) you are requesting:


You may choose one or more of the following you would like the speaker(s) to address:

Tocqueville Society ($10,000+)
General Leadership Giving ($1200+)
African American Leadership Initiative ($1200+)
Women's Leadership Council ($1200+)
Young Leaders Society ($500 up to age 30, $800 up to age 40)
Resource Allocation and Program Investment

You will receive a printable receipt via email after submitting your request. Once your speaker is confirmed, you will receive another email with contact information for your speaker.