ADL Speakers Bureau Speaker Request Form Organization:*Contact Name and Title:*Event Address:*Phone 1:*Phone 2 - CellE-Mail:*Speaker Presentation Topic:*Anti-SemitismTerrorism/ExtremismIsraelCivil RightsSuggest Another Topic:Preferred Program Date(s):*Program Start - End Time:*Expected Audience #:*Audience Age RangeBrief Description of Audience*Are you able to provide A/V Equipment?* Laptop Screen Projector Speakers Microphone The requested honorarium for ADL speakers is $1,000. Please indicate if your organization is able to accommodate this (yes or no).* yes no Are you considering publicizing this event in local media? If yes, please work with our office to approve any copy before releasing it to the public.* yes no Questions or Comments:
