Every seven minutes someone in America becomes legally blind or visually impaired.

Speaking Engagement Report Form

If you have recently completed a speaking engagement on behalf of GDD, we want to hear about it!
Please submit one form for each speaking engagement you have completed.

An * indicates a required field.

* Your Name:

* Address:

* City:

* State: * ZIP Code:

* Phone:

* Email:

Speaking Engagement Information:

*How many hours did you spend at this speaking engagement?
(Include time invested before, during and after speech):

* Out-of-pocket expenses incurred while volunteering: $

Out-of-pocket expenses incurred while volunteering are tax-deductible.
It is a volunteer’s responsibility to keep accurate records and to provide
your tax preparer with appropriate record keeping.

* Date of Speaking Engagement:

* Location of Engagement:

* Contact:

Contact Phone:

* Est. # People Served: Children Adults Seniors

Speech Recap:

*Please provide a brief description of this speech and about your target audience:

*Any lessons learned from this engagement? Things that worked? Things you would change?:

Did cash or in-kind donations immediately result from this speaking engagement?

If "Yes" What was the Amount? Item(s):

Other comments:

Thank you for your feedback and please keep us informed about the wonderful community volunteer activities you are doing in your community!