Request a Speaker

2. First Name
3. Last Name
5. Organization/company name
6. Email
8. Phone Number
9. Name and brief description of event (if not evident in event name)
11. Location of event (please be specific)
12. Date and time of your event (if you have flexibility, please provide preferred dates)
14. What is the age range of the audience?
16. How many people do you expect at this event?

    1. 20 to 30
    2. 31 to 50
    3. 51 to 100
    4. 200+
17. What is the nature of your request?

    1. Classroom presentation
    2. Speaking/lecture
    3. Tabling/exhibiting
    4. Both tabling and speaking
    5. Other
19. If other please describe
21. What would you like ACDEM to speak about?

    1. Recycling Right
    2. Backyard Composting
    3. Household Hazardous Waste: Dangers and Identification
    4. Introduction to waste reduction in Allen County (overview of ACDEM's services)
    5. Lunch Waste Audit
    6. Vermicomposting
    7. Zero Waste and Sustainability
    8. Other
23. If Other, please describe
25. In addition to speaking, will your organization need the following

    1. A hands on activity
    2. Giveaway prizes
    3. Other
27. If Other, please describe
29. What technology and equipment will be available to ACDEM staff?

    1. Laptop/computer
    2. HDMI Cable
    3. Projector and screen
    4. WiFi
    5. None (please bring your own equipment)
    6. Other
31. If Other, please explain
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

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