Nevada Fight Fraud

Speaker Request Form

Please fill out the information included in the form below and someone from Fight Fraud will get back to you as soon as possible. We look forward to working with you!
-Elisabeth Daniels, Nevada Fight Fraud Chairperson

ENTRY
Please answer the following questions, then click the "Submit" button at the bottom of the form. Asterisk's (*) indicate required fields.

Name of Requestor*

Requestor's Email Address*

Requestor's Telephone Number*

Name of Event*

Date/Time of Event*

URL of Event

Date/Time Speaker is Requested for*

Topic Area of Interest*	Warning signs of scams and tips on how to avoid them Identity Theft and other financial fraud Loan Mod and foreclosure scams Medical fraud Senior scams Other (enter below)

Describe profile of desired Speaker

Brief summary of event logistics/requirements of speaker

Will travel expenses be reimbursed?*	Yes No Negotiable

If you are interested in a specific speaker, please indicate name(s)

1st Choice

2nd Choice

3rdChoice

Is there anything else we should know about your event?

Last Updated: 09/14/11 12:16:42 PM