South Carolina Department of Probation, Parole and Pardon Services Serving the Community...

Request a Speaker

Please fill out the Form below and press the "Submit Request" button when you are done.

Requesting Speakers Bureau Member:

Requesting Permission to Speak:

Requester:*

Requester: Please include the requester name

Requester Topic:*

Requested Topic: Please include the speaker topic

Organization Name:*

Organization Name: Please fill in the organization name

Organization Address:*

Organization Address: Please fill in the organization address

Organization Contact Name:*

Organization Contact Name: Please include the contact name

Phone:

Telephone Number: only numeric characters allowed( 10-15 ).

Telephone Number: Please enter your telephone number.

Fax:

Fax: only numeric characters allowed( 10 - 15 ).

Fax: Please enter your fax number.

E-Mail:*

E-Mail: Please enter your email address.

E-Mail: Please enter valid email address.

Date of event:*

Date of Event: Please select the event date

Anticipated Time of Presentation:*

Anticipated Time of Presentation: Please indicate the event time

Number of Expected Attendance:*

Prior Presentation by SCDPPPS?: *

Yes

When and What Topic:*

When and What Topic: Please enter your Topic.

Needed Equipment:

LCD Projector

Projector Screen

Display Board

Microphone

Other

Needed Equipment Other:*

Other: Please indicate other needed equipment in the text box provided