Speakers Bureau Recommendation Please use this form to recommend individuals for inclusion in the Early On Speakers Bureau. EOT&TA will contact the individual to request permission prior to posting the name online. Your name and contact information will not be shared. They are requested so that we may contact you, if necessary, for clarification. Thank you for sharing your resources with Early On® Michigan personnel. Your Information Your Name Your Email Address Speaker Information First Name Last Name Title Organization Email Phone ( ) - ext TTY ( ) - Fax ( ) - Address City State Zip Web Address * use http:// Description Submit Speaker