Speaker Request Form 2022
Use this form to fill out your groups information and provide your choice of speakers
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Contact Information
This information will be used for match correspondence - PLEASE make sure that whspeakersbureau@gmail.com emails do not go to your spam.
Your name or person acting as contact *
Email *
Organization *
Address of organization *
Speaking Engagement Details
Date of Speaking Engagement *
MM
/
DD
/
YYYY
Alternate Date if applicable
MM
/
DD
/
YYYY
Start Time of Speaking Engagement *
Time
:
Options for Location of Speaking Engagement *
Expected size of audience *
Approx. length of speaking engagement *
Apprx. age range of audience *
Required
Do you need any of the following if in-person? (we will try our best to help accommodate)
Topic Request
We cannot guarantee your first choice. We will try to get back to you within 3 business days of your match.
Your first choice of topic (copy and paste title of talk) *
Your second choice of topic (copy and paste title of talk) *
Your third choice of topic (copy and paste title of talk) *
Other
Would you like to add the email address you provided to a yearly mailing list (updates and pdf of topics)? *
Once matched - would you like us to promote your speaking event on our social media platforms? *
How or where did you hear about the WH Speakers Bureau?
Any comments or questions or concerns? We will send a post-engagement survey as well.
Submit
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