Speaker Report

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Speaker Report Form

Please fill out the form below as completely as possible when filing reports for your events. When you press Send below, the form will be copied automatically to an e-mail and sent to the appropriate staff at PFLAG New Hampshire.  If you have any problems, contact Erica by . Thank you!

    Your Name (required)

    Your Email (required)

    Event Date (required)

    Event Name (required)

    Address of Event

    Contact Person for Event

    Contact Phone

    Contact Address

    Contact E-mail

    Speaker Names

    Target Audience

    Number of Attendees

    Topic

    Printed Materials Distributed

    Number of Printed Materials Distributed

    Length of Presentation

    Mileage (include for each speaker)

    Have you spoken here before?

    YesNo

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