Request a Speaker

Name

Email Address

Phone Number

Website

Message

Name of Group

Estimated Number in Attendance

Date and Time of Event

Location of Event (include address)

Brief Description and Focus of the Event

Length of Talk Time and Entire Event

Room Description (classroom, auditorium, etc.)

Program Recipients (ex. middle school students)

Special Considerations (hearing impairment, literacy levels, trauma history, etc)

Are you able to provide the necessary equipment and technology for a PowerPoint presentation? (Projector, Screen/TV, HDMI cord, Microphone, Speakers, etc.?)

Are you able to provide an honorarium and if necessary cover travel expenses? (Honorarium suggested.) Are you able to provide an honorarium and if necessary cover travel expenses? (Honorarium suggested.)YesNoLet me check on that

Can we tell people that we're working with you? We like to share our happenings on social media. Can we tell people that we're working with you? We like to share our happenings on social media.Yes!No thank youLet me check on that