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Speakers' Bureau Request

The Speakers' Bureau is a free community service to organizations in the NorthShore University HealthSystem service area.  As a courtesy to our speakers, we request a minimum of 20 participants at the presentation, or a 24 hour cancellation notice.  A minimum 3 weeks is required for all requests. NorthShore University HealthSystem will make every effort to try and accomodate your request.

   

(Salutation, First, Last)		    
 
Phone
Address Where Presentation will be Hosted 
 
City/ State/ ZIP*    


(please list in order of preference)

  
   
1. Date* Time*
2. Date Time
Number of Participants
Audience
  1.       
  2.      
  3.      
  4.      

Age
(please check all that apply)
  1.       
  2.      
  3.      
  4.      

AV Availability
  1.       
  2.      

  3.   
  4.               

Additional Comments