SPEAKER REQUEST FORM

Facilities available:
Data projector	Overhead projector     DVD Player
Date of engagement:
Start time:
End time:
Would you prefer the speaker to be a specific gender? If yes,		Male	Female
Would you like a HIV positive speaker?  Yes        No

	AUDIENCE INFORMATION
	Total number of audience:
	Audience knowledge of HIV AIDS:		None	Basic	Extensive
	Please write a short paragraph explaining your reason for requesting a speaker, the topics you would like to have covered and what you would like your group to get from the presentation:
	Date:		Requestor:

Thankyou for your request, we will contact you to confirm your booking.