SPEAKER REQUEST FORM

This form should be filled out and submited to the Education Department.  This form should be sent into the Education Department a minimum of two weeks prior to the date for which you are requesting a speaker.

Group/Organization

  

Date of Meeting Time

  

Place

  

Audience

  

Anticipated No.
Description, i.e. adults, etc.

  

Speaker/Program Requesting  

  

Name

  

Topic

  

Contact Phone

  

Comments

  
   

 

Requests can also be made by phone.
Call the Education Department at

225-3470 or 1-800-562-9753 extension 3470.

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Marquette General Hospital

420 W. Magnetic, Marquette, MI 49855


Linda Winslow