If you are a qualified charity in need of a professional speaker for your next event, we have members willing to donate their services to you.

Please fill out this Qualifications Questionaire, and those qualifying will be given access to the list of speakers who are currently donating their time giving speeches for charity.

Thank you for your interest.

Organization's Information
Full Name
Street
City / State / Zipcode	/ /

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Federal Non-Profit ID Number
Organization's Regional Scope	... National State Local

Is the organization registered with National Charities Information Bureau or Council of Better Business Bureaus?

Yes   No

Description of services offered and recipients

Does the organization have an advertising agency, or a budget to hire speakers (not counting reimbursement for transportation and meals)?

Yes   No

Contact's Information
Full Name
Title/Position
Daytime Telephone
Email Address