Speaker's Bureau Form "*" indicates required fields Group's Name*Description of the Group's Purpose or MissionRequestor's Name* First Last Requestor's Email* Enter Email Confirm Email Requestor's Phone Number*Meeting Date* MM slash DD slash YYYY Time* Hours : Minutes AM PM AM/PM Meeting Location*Estimated Number of Attendees*Requested Length of Presentation*Audio/Visual Capability AvailableAdditional Helpful Information (optional)Terms and Conditions* I have read and accept the Terms and Conditions of the Cape Canaveral Lighthouse Foundation. CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ