We are pleased that you have expressed an interest in the MCHRC’s Speakers’ Bureau. In order to meet your expectations, we ask that you complete this brief form and return it to us.

1. Topic desired:
______History and Functioning of the Monmouth County Human Relations Commission
______Understanding and combating hate, intolerance, and bias
______Presentation by particular affinity group(s), e.g., racial, ethnic, gender, religious, disability
Please specify other topic:_______________________________________________
___________________________________________________________________
___________________________________________________________________

2. Date(s) preferred:__________________________________________________

3. Exact location of the presentation_______________________________________

4. Is the location accessible for people with disabilities? ___yes ___no

5. Starting time______________________

6. Total time allowed for our presentation:
    ____15 minutes ____ 30 minutes ____ 45 minutes____ 1 hour ____ other:_______
      (We have found it important to allow time for feedback and discussion.)

7. Approximate audience size: ____under 10 ___under 25 _____25-50 _____50-75
       _____75-100 _____other (how many?): _______

8. Type of organization or group sponsoring the event ______________________

9. Type of audience expected ___________________________________________

10. Familiarity level of audience with topic __________________________________

12. Is this speaker request part of an overall event? ___no ___yes (event type?___ ______)

13. Equipment available: ____ overhead projector ___ video player
       ____easel with paper ____ microphone ____ audiotape player____ Powepoint plugin

14. Please give name and telephone/fax number of person to contact______________
__________________________________________________________________

Please return form as soon as possible to: Carolyn Schwebel (Phone/Fax:  732-291-4257, email: cs@equalizers.org) or call for postal address.