Speaker Request Form

Mission Statement: The Erie County Public Library’s Bookmobile delivers library services to individuals and groups who are not served or who are undeserved by traditional branch libraries because of physical, economic, social, geographic or other barriers.

If requesting a one-time visit, please submit this form at least 4 weeks in advance, but no sooner than three months prior to the visit date.

The Outreach Services team will respond to your request within five business days to determine availability for one-time visits. While we cannot guarantee the availability to add the requested stop, we thoroughly consider all requests.

First Name

Last Name

Name of Organization

Email Address

Phone

Event Title *

Event Date *

Event Overview *

Venue Address *

Venue Description/ room layout (i.e. auditorium, ballroom, conference room, stage, podium, projector, etc.)

Topic of Presentation *

Length of Requested Presentation *30 minutes1 hour

Do speakers typically use PowerPoint slides, photos, or videos for this event? *

Will the speaker be expected to answer audience questions following their remarks? *YesNo

Are there exhibitor opportunities? *YesNo

Media Engagement? *OpenClosedConfirmed CoverageOther

Please explain if Other

Audience and Key Participants *StudentsElected OfficialsBusiness LeadersEducatorsGeneral PublicOther

Please explain if Other

Audience Size *10-5050-100100-200Other

Please explain if Other

Audiovisual Capabilities *YesNo

Submit