Speaker Request

2. Name*

4. Organization*

6. Email*

7. Phone*

9. Name and brief description of your group. For student, please provide grades/ages.*

11. Please provide the preferred date(s)/time(s) for a speaker to visit your group*

13. Location of speaking engagement? Please provide address and room information

15. How long would you like for the speaker to talk?*

16. Approximate size of audience*

18. If audio/visual equipment is available, please describe.

20. Which topic(s) you'd like the speaker to cover?

    1. Where your water comes from & how it's treated
    2. Tap water hot topics & common questions
    3. What happens after the flush: Collecting & treating wastewater
    4. History of water service in Charleston
    5. The water cycle and how we fit in
    6. Water efficiency

22. Would you like the speaker to address any other topics?

24. Additional Comments

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field