Cancer Resource CenterCancer Information Services

Speaker Request Form

Cancer Resource Center provides speakers to service groups, wellness centers and other community groups that want to learn more about prevention and treatment of cancer.

All presentations are subject to speaker availability and may be subject to distance limitations.

Name of Organization:  
Contact Name:  
Address:  
Email Address:  
Phone Number:  
Fax Number:
Presentation:












Which month and year would you like to schedule the speaking event:
Where would the speaking event occur:
How many will be attending the event:
Room capacity:
Is there PowerPoint availability?:
Yes No
Will there be a microphone/speaker system available?:
Yes No
Is there a podium available?:
Yes No