WARRIORS SPEAK
Your Information
Indicates Required Fields
Host Organization:
Organization Type:
Company
Government Agency
Non-Profit Group
Other (Specify -->)
Schools and Youth Groups
WWP
Main Contact
Day of Event Contact
Name:
Same as Main Contact
Title:
Street:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
GU
PR
VI
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
GU
PR
VI
Zip:
Phone:
Cell:
Email:
Venue/Location
Virtual Event
Name:
Street:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
GU
PR
VI
Zip:
Phone:
Event
Event Name:
Event Start Date (mm/dd/yyyy)
Event End Date (mm/dd/yyyy)
Event Type:
Broadcast
Ceremony
Conference
Dinner/Party
Festival
Formal/Reception
Lecture Series
Meeting
Parade
Shadow
Sporting Event
WS Speaker
Representative Type:
Speech
Check Presentation
To Be Honored
Information Booth
Speaker Arrival:
Arrival Time:
12:00
12:15
12:30
12:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
AM
PM
Speaker Presentation:
Presentation Start Time
12:00
12:15
12:30
12:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
AM
PM
End Time
12:00
12:15
12:30
12:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
AM
PM
Speech Length:
Speaker Attire
(business/corporate, business casual, casual):
Does your event have a donation component?
(e.g. fundraiser, check presentation):
Yes
No
Attendees
Average/expected attendance
(e.g. 100 attendees):
Notes
Could you briefly describe your event?
Was there any theme you wanted the speaker to incorporate alongside them sharing their story and talking about how WWP helps?
Notes:
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