Please print and fill out this form to request a speaker from the Bucks County Master Gardener Speakers Bureau.
Date of request:__________________________________________________
Requested by:____________________________________________________
Name of group/organization:________________________________________
Contact name, address, phone & e-mail:_______________________________
____________________________________________________________
Presentation day/date:_____________________________________________
Presenter set-up time:_____________________________________________
Presentation time (prior to any business meeting, please):_________________
Topic 1st choice:__________________________________________________
Topic 2nd choice:__________________________________________________
Topic 3rd choice:__________________________________________________
Presentation site address / room location:______________________________
________________________________________________________________
________________________________________________________________
Type of presentation requested (circle one):
- Lecture only
- hands-on
- both
Budget for hands-on workshop?
- Y / N (if yes, please provide details.)
OK to bring handouts / publications / samples?
- Y / N
Target audience & experience:_______________________________________
Expected attendance number:_______________________________________
Specific instructions for presenter on arrival:____________________________
________________________________________________________________
________________________________________________________________
Additional comments:_____________________________________________
________________________________________________________________
________________________________________________________________
Please email (preferred) or mail the completed form to:
Amy Kwasnicki, Master Gardener Coordinator
Penn State Extension Bucks County
576 Penns Park Road, Suite EXT
Newtown, PA 18940
Email: axk6259@psu.edu
