TABLE OF CONTENTS -- NHTSA Home

appendix fourteen

Speaker Agreement

speaker agreement

I have read the Tips for Speakers and agree to abide by them. If I do not, I understand that I may be removed from panel participation.

I wish to speak on the Impact Panel because:

________________________________________________________________

________________________________________________________________

I believe the greatest strengths I bring to the program are:

________________________________________________________________

________________________________________________________________

I believe the areas that could be troublesome to me are:

________________________________________________________________

________________________________________________________________

I agree to speak on the following conditions:

Where?__________________________________________________________

How often?_______________________________________________________

Dates to avoid:

Birthdays:________________________________________________________

Anniversaries:_____________________________________________________

Holidays:_________________________________________________________

Other:___________________________________________________________

This agreement will be reconsidered in ______ months.

______________________________________________________
Speaker Signature Date

______________________________________________________
Panel Coordinator Signature Date

Offender Speaker Agreement

offender speaker agreement

• I have read the Tips for Speakers and agree to abide by them. If I do not, I understand that I may be removed from panel participation.

• I understand and agree that I have completed my criminal justice sanctions.

• I understand and agree that I will participate on this panel only if and as long as the victims of my crime approve of my participation.

• I understand and agree that my presentation will not deviate from the presentation I have given to the panel coordinator.

• I understand and agree that the panel coordinator or the victims of my crime may terminate my participation in this program at any time without explanation.

I agree to speak on the following conditions:

Where?__________________________________________________________

How often?______________________________________________________

Dates to avoid:

Birthdays:______________________________________________________

Anniversaries:___________________________________________________

Holidays:_______________________________________________________

Other:_________________________________________________________

This agreement will be reconsidered in ______ months.

______________________________________________________
Speaker Signature Date

______________________________________________________
Panel Coordinator Signature Date

Back -- TABLE OF CONTENTS