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SPEAKER REQUEST FORM

Please provide the following information for each request:

  • Requested topic(s) - prioritized, if more than one choice



  • Brief description of the event or program



  • Dates, times and length of presentation - provide options, if possible



  • Number of times the presentation is to be given



  • Description of audience and estimated number of attendees



  • Location of the presentation - include county



  • Directions to the location of the presentation



  • Contact person - include work or home address,
        work and home phone numbers, and an e-mail address



  • Thank you. Please submit the completed request form to:

    Marc Rogoff
    Speakers Program Coordinator

    Phone: 609-292-1474
    marc.rogoff@dep.state.nj.us

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