Americans For Fair Taxation

Speaker Request Form

Please give us at least 3 to 4 weeks to locate an appropriate speaker.

Question - Not Required - Organization:

Question - Not Required - Contact Name:

Question - Not Required - Phone Number:

Question - Not Required - Cell Number:

Question - Not Required - Email:

Question - Not Required - Date of Event:

Question - Not Required - Time:

Question - Not Required - Length of Talk:

Question - Not Required - Location:

Question - Not Required - Street Address:

Question - Not Required - City:

Question - Not Required - State:

Question - Not Required - Notes/Additional Information:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Is your group: Politically Active?
Seeking Information?

Question - Not Required - Is your group: Large (over 100)
Medium (50 - 100)
Small (under 50)

Question - Not Required - Is your group involved with other activist organizations?

Question - Not Required - If Yes, Which?

(Maximum response 255 chars, approx. 5 rows of text)

	Speaker Request Form Please give us at least 3 to 4 weeks to locate an appropriate speaker.
	Question - Not Required - Organization:
	Question - Not Required - Contact Name:
	Question - Not Required - Phone Number:
	Question - Not Required - Cell Number:
	Question - Not Required - Email:
	Question - Not Required - Date of Event:
	Question - Not Required - Time:
	Question - Not Required - Length of Talk:
	Question - Not Required - Location:
	Question - Not Required - Street Address:
	Question - Not Required - City:
	Question - Not Required - State:
	Question - Not Required - Notes/Additional Information: (Maximum response 255 chars, approx. 5 rows of text)
	Question - Not Required - Is your group: Politically Active? Seeking Information?
	Question - Not Required - Is your group: Large (over 100) Medium (50 - 100) Small (under 50)
	Question - Not Required - Is your group involved with other activist organizations?
	Question - Not Required - If Yes, Which? (Maximum response 255 chars, approx. 5 rows of text)