Speaker Request Form

Thank you for your interest in having Questar III District Superintendent Dr. Gladys I. Cruz speak at your event. To check on her availability, please complete the following form at least eight weeks before your event. We highly recommend submitting your request as far in advance of your event as possible. Please note that it is not possible to accommodate all invitations due to the large number of requests we receive. Her assistant Janet Sawyer will contact you to notify you of Dr. Cruz’s availability. Thank you.

Requester Information

Name(Required)

First Last

Organization(Required)

Email Address(Required)

Phone Number(Required)

Event Information

Name of Event(Required)

Host Organization(Required)

Date of Event(Required)

Start Time of Event(Required)

End Time of Event(Required)

What Time Will Gladys Speak(Required)

Location/Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Description of Your Event(Required)

Audience Information

Intended Audience for Your Event(Required)

Expected Size of Your Audience(Required)

Engagement/Presentation Information

Please Indicate the Type of Engagement Being Requested(Required)

Other

How Much Time Is Allocated for Her Remarks?(Required)

What Are Your Recommended or Suggested Topics?(Required)

Will There Be a Question-And-Answer Session to Follow?(Required)

Yes

Is Your Organization Paying for Any Expenses to Attend Your Event, Such as Registration, Travel or Lodging Fees?(Required)

Yes

Other Information – Please Note if Gladys Is Expected to Participate in Any Other Activities Such as Pre- Or Post-event Luncheons or Dinners, Etc.