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LGBT Panel Program

To request a speakers panel for your group or organization, please complete the information below (basic contact information is required). Once submited, you will be contacted by the Center for LGBT Life to set up a panel that is appropriate for the needs of your group/organization. You will also receive a copy of this request via email.

Information in BOLD is required.

Contact Information

Name of Department/Organization:
Name of Contact Person:
Duke Affiliation:
Email Address:
Phone Number:
How did you learn about the LGBT Panel Program:

Panel Information

Preferred Date of Presentation (MM/DD/YYYY):
Preferred Time of Presentation:
(Please include AM or PM)
Preferred Location of Presentation:
Size of audience:

Intended audience for presentation:

Describe topics of special interest which you would like addressed during the panel presentation: