Speakers Bureau Program Form

To apply for a Speakers Bureau program,
print out and submit a completed application form, send it to:

Ohio Humanities Council
Speakers Bureau Program
471 E. Broad St., Suite 1620
Columbus, Ohio 43215-3857

Request Form in Adobe PDF Acrobat Format

Download a version of Adobe Acrobat

or fill out our Electronic Form:

Speaker Program Request Form

          Booking Information

Contact Person:

Organization:

Address:

Phone:
     (day)

(evening)

Email:

FAX:

Speaker/Title Requested:

Date/Time Requested: (Must confirm date and time with speaker before submitting.)

Confirmed the date/time with the speaker: Yes

Time Reserved for Speaker’s Talk (min.):

Anticipated Audience Size:

Location of Program Including Address:

Program Contact Person:

Cost Sharing

The contract fee you pay to the Ohio Humanities Council counts as cash cost share.

The contract fees are as follows:

Non-profit organizations with an annual budget under $100,000 pay a fee of $50. (Plus a $25 travel fee if the speaker travels more than 120 miles one way.)

Non-profit organizations with an annual budget over $100,000 pay a fee of $125. (Plus a $25 travel fee if the speaker travels more than 120 miles one way.)

Schools, colleges/universities and corporate/private entities pay a fee of $250. (Plus a $25 travel fee if the speaker travels more than 120 miles one way.)

For assistance in estimating cost sharing, please contact Frank Dunkle at 614/461-7802, 800/293-9774 or send an email to: frankd@ohiohumanities.org

You must estimate the value of the following:

Volunteer Time ($l0/hour) $

Meeting Room $

Refreshments $

Telephone $

Miscellaneous $

Contract Fee $50, $125, or $250 $

Travel Fee $25 (Only if speaker travels more than 120 miles one way.) $



TOTAL:
$