Speakers Bureau Form Page - Ohio Humanities

Speakers Form

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

Contact Person *

Contact Person's Title

Organization *

Organization's Annual Budget *

Address *

City *

State *

Zip / Post Code *

Phone *

Email *

Speaker Requested *

Title Requested *

Date/Time Requested *

You must confirm with Speaker before submitting your application.

Confirmed Date/Time with Speaker *

Time Reserved for Speakers Talk

Anticipated Audience Size

Location of Program Including Address *

City *

State *

Zip / Post Code *

Non-profit organizations with an annual budget under $150,000 pay a fee of $50.00

Non-profit organizations with an annual budget over $150,000 pay a fee of $250.00

Schools (including colleges or universities) and corporate or private entities pay a fee of $400.00