Name of organization:

Contact person:


Event date and time:


Event location:


Type of Event:


Number of people expected:


Topics of interest to your group:

Organization mailing address:

Street address:


Street address2:

City, State, Zip:

Phone:

Fax:

E-mail:

Web site:

The Purdue Speakers Bureau will respond to your request as soon as possible, usually within a day or two. You may contact the office directly at speakers@purdue.edu or (765) 494-9318. Thank you!