valley united way Speaker Request Form

If you are interested in having a speaker attend a workplace campaign event, please fill out this form which will be sent directly to our President and CPO, Mike Pacowta.

Are you interested in having a speaker from Valley United Way? Are you interested in having a speaker from Valley United Way? Yes No

Are you interested in having a speaker from one of our partner agencies? Are you interested in having a speaker from one of our partner agencies? Yes No

If you have a specific issue you would like addressed, or agency you would like to attend, please let us know here:

Is this event virtual or in person Is this event virtual or in person Virtual In person Other

Please provide options for the time and date of the event

First Name

Last Name

Email Address

Phone

Other Comments:

2 + 1 =

valley united way Speaker Request Form

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