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Frannie’s Friends Speakers’ Bureau Request Form


This form is to be used by anyone making a request and then submitted to The Rev Karen Joy Kelly via email: karenjoykelly@verizon.net. She will then assign a speaker who will follow through with the request. It is to be used for building a data base and for continued improvement to presentations. Please copy and save to your computer. Simply fill out the information and then save. It is then ready to email. Your assistance is critical. Thank you!


Name of organization:




City:                                                      Zip Code:


Contact Person:


Telephone:                                             Email:



Date requested:


Location of presentation:


Address if different from above:



Number in audience:


Speaker Assigned:


Follow up Thank You sent:


Any further comments re presentation:




YWCA Central Virginia • 626 Church Street • Lynchburg, VA 24504
ywcacentralvirginia@ywconnect.org • Phone: 434-847-7751 • Fax: 434-528-3449
Copyright 2012