Speakers Bureau Intake Form

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Thank you for choosing the Chester County Intermediate Unit (CCIU) to schedule a presenter/speaker for your upcoming meeting or event. We know you had a choice, and we’re glad you chose CCIU! Kindly complete the form below and we’ll contact you to review your request and confirm scheduling. Again, thank you for your interest in the Chester County Intermediate Unit.

1.	Contact's First and Last Name*

2.	Contact’s School/District or Organization*

3.	Contact’s Address*

4.	Contact’s Email Address*

5.	Contact’s Phone Number*

6.	What topic(s) are you interested in learning about?*