University of Wisconsin-Madison

LGBT Campus Center Speakers Bureau Request Form

Thank you for your interest in the Speakers Bureau program. If you would like to schedule a speaking event, please fill out the following form. Print forms are also available in the Campus Center.

Please request at least two dates and times.

Contact Information

Name: Organization/Class:
Email: Phone:
Campus Address:

The Event

Meeting Place:
Dates Requested: Times:
Length of event:
How many people?:
Reason for request:

Thank you. We'll contact you within a few days to continue planning.