Hennepin County Government Center 300 S. Sixth Street Minneapolis, MN 55487 Web site: www.mncourts.gov/district/4/ SPEAKERS BUREAU REQUEST FORM Judicial officers and staff welcome the opportunity to present to your organization at no charge on the topics listed below. Please complete and return this form at least 30 days before your event. If you have any questions, contact Nancy Peters at 612-348-5022. Thank you for your interest in learning about the Fourth Judicial District. Arbitration/Settlement Conference Office Administrative Hearing/Collections Office Careers/Training Civil Filing Community Court Conciliation Court Criminal/Traffic Court Domestic Abuse Service Center Drug Court Examiner of Titles Family Court Guardian ad Litem Housing Court Judgments Jury Office Juvenile Court Law/Judicial Clerks Probate/Mental Health Court Self Help Service Center Suburban Courts Traffic Violations Bureau Other courts-related topics Topic: ______________________________________________________________________ Please specify information desired: ________________________________________________ ______________________________________________________________________________ Speaking date(s)_______________________________ Time(s): _________________________ Organization: __________________________________________________________________ Address (street, city, state,): _______________________________________________________ ______________________________________________________________________________ Address where presentation will be given (if different from address above): ________________ ______________________________________________________________________________ Directions to presentation location: ________________________________________________ _______________________________________________________________________ 1 American LegalNet, Inc. www.FormsWorkflow.com SPEAKERS BUREAU REQUEST FORM Contact person: ________________________________________________________________ Telephone: ________________________________ Fax: _____________________________ E-mail address: _____________________________ Date of request: _____________________ Size and profile of audience: ______________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ General description of area / room for presentation: ___________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Audio/visual aids you could provide, if needed: Podium/microphone______________ Overhead projector/screen_____________ VCR and monitor_________________ Easel pads/markers___________________ Other___________________________________________________________________ Special instructions, if any: _______________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ How did you learn about the Speakers Bureau? _______________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Please attach additional information, if needed, and return your completed form by e-mail to: nancy.peters@courts.state.mn.us, by fax: (612) 348-2131, or send to: Nancy Peters, Fourth Judicial District, Office of Public Affairs, C-1251/421 Government Center, 300 S. Sixth St., Minneapolis, MN 55487 Rev. 5/22/08 2 American LegalNet, Inc. www.FormsWorkflow.com