Speakers Bureau Application

You must make arrangements with the speaker before submitting this application. If you need contact information for the speaker, please contact Erica Nunn by calling 602-257-0335 X26 or e-mailing enunn@azhumanities.org.

Have you confirmed the program date, time and title with
each speaker/presenter?* Yes

Applicant Information

Organization Name:
Are you an eligible applicant? Yes No
Address:
City:
State:	ZIP:
Phone:	Fax:
E-mail:
County:
AZ Legislative District:*	Congressional District:*
To find districts based on address, click here.
Person to contact about this form:
Address:
City:
State:	ZIP:
Phone:	Fax:
E-mail:

Speakers Bureau Program

List the program details here.
Date:	Time:	Speaker/Presenter:	Program:


Is there a fee or meal attached to the presentation(s)? Yes No
Program Location (including street address):
Estimated audience size for each program:
Intended Publicity:

Fee Due to AHC:
No. of Program(s) x $50 =	$
Your Required Contribution: AHC asks that you estimate the value of the resources that you are putting into the project.
Staff and Volunteer Time	$
Services and Materials	$
Other	$
Fee Due to AHC (from above)	$
TOTAL CONTRIBUTION*	$
Payment will be due once your application is processed, and due at the same time as the signed contract.
* Required