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Virtual Survivor Speaker
Request
Name of Organization or School
School / Organization Address
City
State / Province / Region
Postal / Zip Code
Country
Type of Event
*
Classroom Speaker
Assembly Speaker
Other
Expected number of attendees
Age range of attendees
Date & Time
Date Requested
*
required
Alternative Date
*
required
Start Time Requested
00:00
00:15
00:30
00:45
01:00
01:15
01:30
01:45
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14:30
Details
How long does the Survivor have to speak?
Speakers require a minimum of 45 minutes to speak.
Primary Contact
Day-Of Phone Number of Event's Primary Contact
E-mail Address of Event's Primary Contact
Please tell us about your group, their familiarity with the Holocaust and any books, literature or films they have learned from.
SUBMIT
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