The Speakers Bureau of Johnson County Community College enhances the college’s visibility and
reputation by providing speakers on a variety of topics to community groups throughout Johnson County.
Please email completed form to Valerie Reese at vreese2@jccc.edu.
Today’s Date: ________
Contact Name: ______________________________________________________________
Contact Phone Number: _______________________________
Contact Email Address: _________________________________________________________
Group or Club Name: __________________________________________________________
Date of Speaker Event: _______
Start Time: ____________________
Length of presentation: ____________________
Location: ___________________________________________________________________
Estimated number of attendees: _____________
Speaker & Topic you are requesting:
Please select 3 options in case your first choice cannot attend
Speaker Choice 1 Topic
________________________________________ ________________________________________
Speaker Choice 2
________________________________________ ________________________________________
Speaker Choice 3
________________________________________ ________________________________________
Brief description of club/group function the speaker will be attending:
Will there be a computer & projector for the speaker to use?
Any comments or additional information:
Revised 1/7/19
Clear Form