United Way Speaker Request Form

Hearing first-hand from a United Way speaker is a great way to let people know how their contributions are helping in the community. Informative and educational, these speakers put faces on the statistics in 5 to 15 minute presentations. The stories they tell will help employees to understand the positive impact their gifts can have on the lives of others. Speakers are very popular so please make your request two weeks in advance. If you have any questions or would like some suggestions, contact your United Way representative or call 845-471-1900 x108.

Organization Holding Meeting: *

LE Name: *

LE Phone Number: *

ECM Name: *

Camapign Team member in charge of the meeting

ECM Phone: *

xxx-xxx-xxxx

Date of Meeting: *

Time of Meeting: *

Date of Meeting(2):

If organization has more than one meeting

Time of Meeting(2):

If the organization would like to meet more than once

Date of Meeting(3):

If organization has more than one meeting

Time of Meeting(3):

If the organization would like to meet more than once

Location of Meeting(s): *

Please provide an address or directions

Number of Employees Attending Meeting:

First Choice of Topic: *

Education

Income

Health

2-1-1

Second Choice Topic:

Education

Income

Health

2-1-1

Comments: