Climate Impacts Group Speaker Request Form
Your answers to this form will help us better understand your needs for a speaker for your event. We will respond to your request as soon as possible.  
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Email *
Your name: *
Your phone number (optional):
Who is the organization hosting this event? Please provide the full name. *
Title of event: *
Will this event be held virtually or in-person? *
State/Location where the event is being held (or hosted, if the event is virtual)   *
City/town/territory where the event is being held (or hosted, if the event is virtual) *
What day is the event?
MM
/
DD
/
YYYY
If you don't have a set day for the event, please provide a timeframe or potential dates:
What time is the event?
Time
:
If you don't have a set time for the event, please provide an approximate time or a few options:
What is the expected time length for the CIG scientist’s presentation (not including the Q&A)? *
Approximately how many people do you expect to attend the event? *
Who is the primary audience for the event? Please select up to three responses. *
Required
What is the purpose of the event? *
Have you already received confirmation from a CIG scientist that they will give this presentation? If so, please list their name(s) below. *
If not, do you have a CIG scientist in mind to speak at this event? If so, please list their name(s) below. Learn more about our staff here: https://cig.uw.edu/about/people/ 
Have other speakers been invited to speak at this event? *
If other speakers have been invited, what are their names and what topics will they be covering?
Is there a fee for attending this event? *
Will you offer travel reimbursement (if relevant) and/or an honorarium for the speakers' time?                       Note: Travel reimbursements and honorariums are not required to secure a CIG speaker, but they are important for offsetting our expenses. *
Is there anything else you'd like us to know about the event? If you've already reached out to a CIG scientist and they agreed to participate in your event, please note that here.
A copy of your responses will be emailed to the address you provided.
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