Master Gardener Speaker Request Form

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:

Kathleen Connally, Master Gardener Coordinator
Penn State Extension Bucks County
Neshaminy Manor Center
1282 Almshouse Road
Doylestown, PA 18901

Email: kxc30@psu.edu

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Master Gardener Speaker Request Form

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