Listening Together Speaker Request Form
Thank you for your interest in inviting Uma Soman and/or Ahladhini Dugar to speak at your next gathering of families or professionals. We provide 1-3 hour presentations or full day and multi-day workshops.
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Email *
First we want to get some information about you and your organization.
Please share as many details as possible. We will not share them with anyone without your permission
Your name *
Name of the organization planning the event / meeting / conference. *
Where is the organization located? (City, State, Country) *
What does the organization do? *
What is your role in this organization? *
Next we want to get information about the event / meeting / conference.
Please share as many details as possible. We will not share them with anyone without your permission
Please tell us about the overall event. (For example, "our organization is hosting an awareness event for International Cochlear Implant Day. We will have multiple speakers make presentations related to post-cochlear implant  rehabilitation during the event.") *
What do you want the topic (s) of the presentation or workshop to be? *
What language do you want the presentation or workshop to be conducted in? (Select all that apply) *
Required
Who are you inviting to give the presentation or workshop? *
Required
How long do you hope Uma Soman to present? *
Required
How do you want Uma and/or Ahladhini to present?
When will the event be held? *
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Where will the event be held? (City, State, Country) *
Who will be in the audience for this presentation or workshop? (Select all that apply) *
Required
How many attendees do you expect? *
Required
What would you like attendees to learn from this presentation? Write 2-3 learning objectives as "At the end of this presentation / workshop, participants will be able to ...." *
Who will be the point person for this event? *
Please share their contact information (Email, phone number, whatsapp, etc.) *
When do you need to know if we can present at your event/meeting? *
Typically, we charge $200/hour per presenter for up to 4 hours, and a different charge if you want a full day workshop. Travel, conference registration, and hotel expenses will be covered by the event organizer. We will send an email with our cost estimate in response to this form. We can work with you to finalize the costs and the speaker's contract.
A copy of your responses will be emailed to the address you provided.
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