If your group is interested in participating in a Speaker Exchange,
Please complete and submit the following form.


NOTE: This is an exchange of speakers between groups outside of the area.
Please do not submit a form if your group does not have a member willing to travel to other areas.


Group's Name:

Group's Address:

Exchange Meeting Day:

Exchange Meeting Date:

Exchange Meeting Time:

Meeting Format (Beginner,Step, Pamphlet,Topic,etc.):

Speaker Clean Time Requirements:

Speaker Exchange Rep. Info




Other Group Particulars: