Speaker Bureau Request Form

Organization Telephone (with area code):

Requested Date (at least 30 days lead time):

Total Number of Attendees (Must be at least 30 people):

Please note: You will be contacted by our volunteer Speakers Bureau coordinator for confirmation. You must cancel if your audience drops below 30 people for any reason.

Speaking Engagement Address

Street address for the location of the speaking engagement:

City:

State:
NEW JERSEY

Zip:

Daytime Telephone (with area code):

Specific Topic of Interest (Please Indicate Up To Four)
Today's AARP
AARP Chapters
AARP Driver Safety Program
Identity Theft
Long-Term Care
The Power of the Senior Vote
Medicare Prescription Drugs (Recommended Topic. Release date: Oct. 15, 2006)
Social Security
Volunteer Opportunities with AARP

Please allow 30 days advance notice to schedule a speaker and for planning purposes.