The Culture of LifeSpeaker Request Form

The Culture of Life

Speaker Request Form

To request a speaker from the Diocese of Orlando Culture of Life office,

please complete form below.

For any further inquiries, email CultureOfLife@cflcc.org

Parish/School/Organization Name*

Parish/School/Organization Website

Presentation Topic*

Select

Other Presentation Topic*

Have you obtained authorization from your pastor, parish staff, or school administration?*

Yes

Pending

N/A

Full name of the pastor/parish staff/school administrator who granted approval*

Approving Leader Email*

What is your name?*

What is your role?*

What is your email address?*

What is your phone number?*

Phone

Presentation Format*

In-Person

Hybrid

Virtual

Presentation Date Choice 1*

Please provide your first choice for a presentation date.

Presentation Date Choice 2

Please provide your first choice for a presentation date.

Presentation Time*

Please specify the desired start/end time.

If the presentation is part of a larger meeting/event, please provide the times for the entire event.

Presentation Location - Full Street Address*

If you are requesting a virtual presentation, please write "n/a."

Anticipated # in Attendance*

Tell us a bit more...*

Why are you requesting this presentation?

What outcomes do you desire from this presentation?

Are there any extra details about your group or audience that would be useful for us to know? Kindly provide any pertinent information.

How did you hear about Culture of Life education opportunities?*

Select

Please specify "other"*

Send me a copy of my responses