David Cornett, Executive Secretary
211 Glenwood Place
Frankfort, Kentucky 40601
Phone: 502-223-2257
Speaker Information Request Form
Name:
Position:
Organization:
Address:
City:
State:
--Select--
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code:
Daytime Phone:
E-mail Address:
Title of Presentation(s):
Length of Service:
Educational Background:
Experience:
Equipment Needs:
PowerPoint Projecting Equipment
Slide Projector and Screen
Overhead Projector and Screen
Other
Additional Information/Requests