Women Against Gun Violence


WAGV ACTION ALERTS – Speaker Request Form Women Against Gun Violence is pleased to provide speakers on the issue of gun violence education and prevention to groups throughout Southern California. A minimum of two weeks is requested for scheduling. First Name: Last Name: Organization: Phone: (day) (evening) (cell) Requested Date: Day of the Week: Requested Time From: To: Email: Speaking Location: Address: City: State: Zip: Speaking Location Phone: Audience Audience (please select one) Adults /Parents Youth/Adults Youth If youth, approximate ages/grades Estimated number of partcipants Estimated number of Spanish-speaking participants Speaker Are you requesting a speaker as part of a panel or event? Yes No If yes, please describe Resources available to speaker (check all available) Easel VCR/TV Additional Comments Thank you for your support and dedication to improving the safety of others.