Speaker and Materials Request

To request a representative from The Association to attend your event or to have materials sent to you distribute, please complete this form. Someone will get back to you to confirm participation. If you have any questions, please call 732-469-7979.

* 1. Contact person making request

* 2. Organization and Location of event

* 3. Contact phone

* 4. Contact email

* 5. Date of Event

When is your event taking place?

* 6. Type of Event

* 7. Please describe your event, including the purpose, goals and audience demographics.

* 8. How many people are you expecting?

* 9. Do you need a speaker or representative from the ADA?
If you answer yes, please explain what is expected. Do you need them to speak? For how long? Should they just be available to answer questions? (Please note: we cannot guarantee that someone from the ADA will be available to attend. We will do our best to accomodate requests with a staff member or volunteer.)

* 10. Do you need materials sent to you? We need at least 3 weeks to have materials mailed out. Please include an address below where information should be shipped and the date they are needed.