Speakers Bureau 
Speaker Request Form

Please provide the following information in as much detail as possible.


I have read the Speakers Bureau Guidelines/Procedure Guide and understand that submitting a request does not guarantee a speaker.


Today's Date:

Requester Name:  

I am a:
If other, please specify:

*We regret that the Center is no longer able to accept student requests.

Name of Group/School:

Address where engagement will take place:  include entire address - number, street, city, state, zip

Office Phone:  

Cell Phone:  

Requester's Email Address:      

Have you hosted a speaker from our Speakers Bureau before?:

Preferred Speaking Dates and Times:
Please provide specific date and time information if possible. We recommend allotting 90 minutes for the speaker – 60 minutes minimum.

From: To:
From: To:
From: To:

Speaker Preference:

Age of Audience:

Projected Number in Attendance:

Educators: Will the students be reading any Holocaust-related books ahead of time? If so, which ones? (Need suggestions? Let us know.)

Educators: What will you be doing to prepare the students for this speaker? (If you are not sure, please let us know – we have worked with many teachers and can share with you some “best practices.”)

Other groups: Please tell us a little bit about your group and goals for the speaker presentation.

Special Needs or Requests: (please use this section to inform us of any information that we may need in order to make the presentation the best possible one for your intended audience)


How did you first hear about us?

Due to concerns with spam filters, if you do not hear from the Holocaust Center within a week of submitting this form, please contact the Center at admin@wsherc.org or 206-774-2201. Thank you.