Speaker Request

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Torrance Police Department
Speaker Request Form

Community Affairs will originate the request an forward it to the appropriate Division.

Please correct the fields below:

Please correct the field(s) marked in red below:

1

Requestor

*

Requestor

Name:

Phone: ext.

Fax: ext.

Address:

E-Mail:

2

Type of Event:

3

Event

*

Event

Date of Event:

Time From:

Time To:

Name of Event, If Any:

Location of Event (name and address):

Explain Topic and Scope Desired: