Virtual Survivor Speaker Request

**If you are interested in inviting a Holocaust survivor to speak to your virtual classroom, community center, or cultural institution, please review the above criteria prior to submitting the Off-Site Speaker Request form.**

We aim to bring Holocaust education and survivor speakers to as many groups as possible, but cannot guarantee speaking requests will be fulfilled.

Name of Organization or School *
School/Organization Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
The school or sponsoring organization must provide transportation for the speaker
Type of Event *

Type of Event Classroom Speaker Assembly Speaker Other Other
Expected numbers of attendees: *
Age range of attendees *
Requested Date * / MM / DD YYYY
Alternative Date * / MM / DD YYYY
Start time requested * : HH MM AM/PM
How long does the Survivor have to speak? *

Speakers require a minimum of 45 minutes to speak
Primary Contact * First Last
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. *