Speaker Request Form - Brevard Zoo

Fields marked with an * are required

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Speaker Request Form

To request a speaker, please fill out and submit the form below. You can also download and email the completed PDF to edregistrar@brevardzoo.org or call 321.254.9453 x219 with any questions.
All groups must register two weeks in advance.

Download PDF

Organization Header

Organization Details

Name of Organization *

Location of Presentation Full Address

Location of Presentation Full Address

Address *

City *

State *

Zip *

County *

Booking/Contact Persons

Booking/Contact Persons

Name *

Phone/Ext. *

Email *

Attendees

Attendees

Please provide the total number of the following:

Children/Students Ages 3 and Up

Children Under 3

Adults

Are there any exceptional needs in your group?

If yes, please elaborate.

Additional

Additional

Is this your first speaker from Brevard Zoo?

How did you learn about us?

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Presentation Details

Presentation Details

Date Requested (first choice)

Alternate Dates (in case your first choice is not available)

Presentation Start Time (round to the nearest quarter hour)

Presentation End Time (round to the nearest quarter hour)

Specific topic of presentation requested

Do you have the technology for a PowerPoint presentation (laptop, projector, screen)?

Additional Needs