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Speakers Bureau Request Form

from: AARP

Complete this form to request an AARP speaker for your next event.

Primary Contact Person*

Organization Name*

Telephone Number*

Street Address*

Organization Mailing Address

City*

State*

Postal Code*

Email Address*

Requested Month for Speaker*

Requested Day*

Requested Year*

Are Dates Tentative or Flexible?

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Is the Event for Multiple Days?

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Month of Event End Date

Last Day of Event

End Date Year

For more information on AARP speakers, please see the AARP Board of Directors and Executive Team biographies.

Will You Accept Another Speaker From AARP?

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If preferred speaker isn’t available

Total Number of Event Attendees *

Address of Speaking Location*

City*

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Postal Code*

Event Website

Topic of Interest

Health Care, Long-Term Care & Caregiving

Financial Security & Social Security

Livable Communities & Driver Safety

Volunteer & Civic Engagement

Older Workers & Encore Careers

Brief description of speech*

Approximate length of remarks: (in minutes)

Has media been invited?*

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*All marked fields are required.

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