Community Engagement and Service Speakers Bureau - Request Form

Thank you for your interest in requesting a speaker from the Fulton County Superior Court. Please use the form below to tell us more about your event, organization and needs. The Public Information Officer will follow up with you via email confirming receipt of your request within three days. Further information will be provided by way of email or telephone upon review of the request. Required fields are marked with *. Use the TAB key to move forward through fields; use SHIFT+TAB to move backwards through fields.

Contact Information of Person Requesting Speaker
  

 * First Name  

 * Last Name  

 * Organization  

 * Primary Phone Number  

  Alternate Phone Number  

 * Email Address  

 * Address  

 * City  

 * State  

 * Zip Code  

 * Country  

Organization Information

 * Type of Organization  

  If other, please specify  

 * Event Date (example: 1/22/2014)  

 * Organization Website  

Event Information

 * Event Name  

 * Event Start time  

 * Event address same as contact address?  

If no, please provide Event Address here:
  Event Location  

  Event Street Address  

  Event City  

  Event State  

  Event Zip Code  

  Event Country  

Presentation Information

 * Topic of Presentation  

  Speaker Requested if known  

  If other, whom  

 * Are there other scheduled speakers  

  If yes, whom  

 * Event open to the press  

  If yes, provide details  

 * Event to be broadcast  

  If yes, provide details  

 * Event to be recorded  

 * Speaker bio needed  

 * Speaker photo needed  

 * Confirmation needed by (example: 1/22/2014)  

 * Is this a political event?  

 * Is this event or any part of it a fundraiser?  

  If yes, is attendance at the event tax deductible?  

  Any other information which may help clarify your request  


* I agree that no person for reason of race, color, sex, religion or national origin will be excluded from or segregated within membership in sponsoring organization, attendance at event or any of the facilitates housing the event.







Office of the Court Administrator
Superior Court of Fulton County
136 Pryor Street, S.W.
Suite C-640
Atlanta, Georgia 30303
Office Number: 404-612-4518
Fax Number: 404-730-5368