Speaker Request Form

Please complete the form below and press the submit button.

Note: Please allow a minimum of 30 days' notice for request review and consideration. Someone from the Sheriff’s Office will reach out to you to request more details or to confirm our availability for your events. Thank you for your patience.

Full Name *

Address *

Address 2

City *

State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virgina Wisconsin Wyoming
Zip Code

Phone *

Cell

Email *

Organization *

Event Name *

Event Date (mm/dd/yyyy) *

Start Time (hh:mi pm)*

End Time (hh:mi pm)*

Event Address *

Event Address 2

Event City *

Event State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virgina Wisconsin Wyoming
Estimated Attendance *

Presentation Topic Requested

Auto Theft Prevention

Bullying and Cyberbullying

Business/Home Security (CPTED - Crime Prevention through Environmental Design)

Child Safety

Cons and Scams

Crimes Affecting Seniors

Drug Awareness

Home Security

Identity Theft/Fraud

Neighborhood Watch

Robbery Prevention for Banks and Businesses

Other

If Other:

Event Details



If you have trouble submitting this information, please call Specialized Services at (407) 665-6880.