Speaker Registration

---

As one of the basic objectives of our Federation is to educate our membership we invite speakers to share their thoughts and ideas with us. Subjects are varied and not limited to the political arena.

For potential inclusion in our Speaker's Roster, please fill out the following form:

*Name:
*Email:
Web Page URL:
*Address:
*City:
*State:	Please SelectAlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces (AE)Armed Forces Americas (AA)Armed Forces Pacific (AP)British ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradoNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPalauPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukonOther
*Zip:
County:
*Phone:
*Travel Restrictions:	Northern California Central California Southern California Statewide
Topic:
Fee:
*Recommended by:
*Email address of recommending party:
*Give details of your audience minimum short resume, previous speaking experience at FRW events and other comments here:
	Yes, I am a registered Republican