Requests for Speakers

Name of Organization:

Contact Person:

Position:

Phone Number:

Email:

Person you are requesting:
Any one of the staff training teamA particular staff person

Date of Presentation:

Topic:

Length of presentation (hour(s)):

Location:
In-PersonVirtual

# of people attending:

Description of audience:

Does your organization cover:
Honorarium. If yes, please indicate amount and currency belowCharges for Hand Outs & MaterialsTechnical SupportTransportationHotelMealsOther