CAPIO-Speaker's Bureau

CALIFORNIA ASSOCIATION OF PUBLIC INFORMATION OFFICIALS (CAPIO)
Speakers’ Bureau Questionnaire

Please take a few minutes to answer the questions below. Send your completed questionnaire to Adrienne Schmeling, 1400 K Street, 4th Floor, Sacramento, CA 95814; or fax to (916) 658-8240.

1. Are you interested in being included in CAPIO’s Speakers’ Bureau?

q Yes q No

2. If yes, on which topics would you consider yourself an expert?

q_______________________________________________________________________

3. Would you use the CAPIO Speakers’ Bureau to find speakers for other organizations?

q Yes q No

4. If yes, for which topics would you consider using the CAPIO Speakers’ Bureau?

q_______________________________________________________________________

5. Where would you be interested in speaking?

q Yes q No

q Northern California q Southern California q Central Valley q Anywhere in Calif.

q L.A. vicinity only q San Diego vicinity only q Bay Area only q Outside Calif.

6. Please provide the following biographical information:

Name: ________________________________Job Title:___________________________

Organization:______________________________________________________________

Address: _________________________________________________________________

_________________________________________________________________________

Phone: ______________ Fax: _____________ E-mail:____________________________

Speaking Experience:_______________________________________________________

_________________________________________________________________________