Speaking Engagement

Name of your organization:

Request submitted by (name, role and email):

Requested speaker:

Preferred topic for the presentation/remarks:

Length of presentation:

Event name & type (conference, public debate/panel discussion, cocktails/reception, fundraiser, etc.):

Date and time:

Location:

Is this a sponsored event? If yes, indicate the sponsor/s.

Event agenda/program:

Are there other presenters or panelists? If yes, who are they?

Audience profile & expected number of attendees:

How will the event be promoted (e.g., will it be broadcasted or promoted via social media)?

Any other information:

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