Speaker request form - Health Care Without Harm Europe

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To request a speaker from Health Care Without Harm (HCWH) Europe to participate in your event or webinar, please fill out this short form to provide details about the organiser, the event/webinar, and the requested speaking slot.

A member of the HCWH Europe team will respond to your request.

Organisation name *

Organisation website

Your name *

Your position *

Your email address *

Confirm email address *

Please re-enter your email address

Name of your event/webinar *

Event/webinar website

Event/webinar location *

Please provide the city where your event will take place. Please indicate if it is an online or hybrid event

Event/webinar description *

Please provide a short description of your event

Event/webinar date *

Please indicate the date of the requested speaking slot

YYYY

Event/webinar end date

YYYY

Audience *

Please indicate the expected audience, e.g. healthcare professionals, policy-makers, academia, industry.

Which speaker are you requesting?

Please leave blank if you are not requesting a specific member of the team

Speaking request *

Keynote speech

Panel discussion

Workshop presentation

Moderator

Other:

Session details *

Please provide a short description of the requested speaking slot, e.g. details of other speakers or presentation requirements

Is there a speaker fee available? *

Please enter an amount or n/a

Are travel and accommodation expenses reimbursed? *

Yes

Additional comments or requests

Please include links to supporting documents e.g. agendas, including drafts, if available

Submit

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