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Request a Road Scholar Ambassador Presentation

Please complete and submit the form below and we will do our best to match your group with an appropriate Road Scholar Ambassador.

  I am requesting an Ambassador to:

 Title  Contact Name

 Contact Phone   Email Address


 Organization Address 
 Location of the Presentation, if different from the address above.

 City  State  Zip/Postal Code

   Yes No
Date of event Start time End time    Is this date/time negotiable?
Please note that we typically book Road Scholar presentation 3-4 months in advance. If you require more time than that, please let us know.

Location of event  Zip code of event    Expected # of attendees

Yes No  
 Will there be a projector, computer and internet access at the event?  

Please include any other important information or comments about your event below:

Check here if your organization would like to receive our catalogs and other informational materials.

Lastly, please let us know how you found out about the Ambassador Program: