Kentucky Aarp Speaker / Booth Request Form

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AARP Speaker / Booth Request Form
Requestor Information
Name of Requestor
Requesting on behalf of
(church, civic org, etc.)
Address of Event
Contact Phone Number
Contact Email
Event Information
Date
Start Time
Desired presentation length
(25 mins, 45 mins, just a table, etc.)
# of Attendees
Screen and projector available?
Microphone available?
Topics (circle one)
Fraud Watch Network
Legislative
Prepare to Care
(Fraud)
(Work and Save, Care Act)
(Caregiving)
Social Security
Other: _____________
Send completed form to: or fax to (502) 423-7031.
For questions, call (866) 295-7275. Minimum group size is 25 people.

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