Request for Speaker

Items marked with an asterisk ( * ) are required.

* Name of Organization

Is organization a non-profit?   No   Yes  

* Contact Person

* Telephone Number Fax Number

* Email

* Confirm Email


City State Zip Code

Date Needed Time

Location of Meeting and Directions

Length of Time Allowed for Presentation

Number Expected to Attend

Equipment Needs: Screen or appropriate wall on which to project visual presentation; a table for projector, and an electrical outlet.

Although the visual presentation is a general overview of the College and the multiple satellite education centers, please list any specific topics you wish your speaker to address.

Comments/Special Instructions

For additional information, please contact:

    President's Office
    Montgomery County Community College
    College Hall, Suite 272
    340 DeKalb Pike
    Blue Bell, PA 19422
    Telephone: 215-619-7419