Request a speaker If you would like to request a CSEC awareness presentation for your event, please fill out and submit the form below. Contact Information* First Name Last Name Email* Phone* Please check the box that best characterizes your group School Civic Group Faith Group Other Event Information Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificState ZIP Code Site of Event (Please include site name, if applicable.) Date of Event Event Time : HH MM AMPM Time Speaker Must Be Present : HH MM AMPM Length of time given to Street Grace speaker* 15 Minutes 30 Minutes 1 Hour 2 Hours Other speakers you will be inviting to the event: Expected number of attendees: Additional Questions or Comments: Phone number for contact who will be on site the day of the event, if different from above. I understand that this form operates only as a request. The completion and submission of this form does not signify that Street Grace has agreed to participate in my event. Furthermore, I understand that any and all speaker requests are fulfilled on the basis of availability and cannot be guaranteed.* I acknowledge the above disclaimer.