Speaker Request

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     We appreciate your interest in our agency to provide your event with a speaker. Due to the High volumes of requests we can only approve a select few each month.

We also ask that our speakers be compensated for their time. Once you have filled out the “Contact Us” form someone will be in   touch with you with the speaker request form with the speakers fees included.

 

Please fill out the Speakers Request form below to move forward with your request. Use the directions below to help you navigate through the process.

 


Please include the following in “Contact us” form:

 


Image result for dot  Your name and Agency Name 

 

 

 

Image result for dot  In subject line please type “Speaker Request” 

(to insure your request to the right department)

 

 

   Image result for dot  Your email Address –

(person in charge of event)

 

Lastly in your message please tell us in detail what you are seeking in a speaker

(include topic)

 

Image result for dot  Items you’ll want handed out during speaker’s session if any

 

 

Image result for dot  If HIV testing will be needed

 

 

Image result for dot  If Hep C testing will be needed

 

Image result for dot  If speaker can sale books

 

Image result for dot  If donations can be taken up

 

Image result for dot  Where the event will be located

 

Image result for dot  Date and time of event

 

 

 

 

 

 

 

And any other information shared that we will need to insure your event is selected

 

 

 Note: the more information you give the better we can serve you with a speaker.

 

 

Again thank you for your interest we look forward to working with you.

Please complete the information below.

 

Verification

 

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