Public Information Speaker Request for Non AA Functions

Please fill in all the areas and then press the "submit button" below to send information to AA San Diego Central Office.

Speaker Requested for: Time:	Date:	Day of Week:
Organization Requesting:
Complete Address:
Room Number:	Community: (i.e. Hillcrest)
Is a TV and VCR available?  Yes   No
Person Requesting:
Home Phone#:	Work Phone#:
Number of Speakers:	Male:	Female
Type of Group:
REMINDER: We need at least ten (10) working days notice for Speaker Requests to allow us adequate time to arrange for the speaker. ALSO, it is very important that all items listed above be completed in full, especially the requestor's home phone number.