Kareem Weaver Speaker Request Form

Thank you for considering Kareem as a speaker for your event and completing this form so that we can evaluate the opportunity. 

We will review requests on the 3rd Friday of every month and will provide responses within 3-4 business days. Please provide a lead time of 4-6 months for in-person speaking engagements and 2-4 months for virtual engagements. 

This month we will be evaluating requests on Friday, April 19th before 12 PM PT, and aim to provide notification of our decision by Friday, April 26th.

We have received an overwhelming amount of requests, and thank you for your patience as we evaluate yours. If you have any further questions, please contact Trinity Hansen at trinity@fulcrum-oakland.org.

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Email *
First and last name  *
Organization/Company/Entity Name  *
Please share your company's website (if applicable)
Where is your organization located? (City, State) Please indicate, even if being held virtually  *
Please share the mission of your organization briefly  *
If this is a collaboration between your organization and others, please include their information as well 
When would you like to host the event? (If there are multiple possibilities, please put the earliest date in this field) Please include your preferred dates and the starting time in local time *
Please add the alternative dates here (if applicable)
How would you like Kareem to participate in your event? (Panel? Keynote? Presentation? Breakout Sessions?) Please provide as much detail as possible, including the time commitment requested.  *
Do you want Kareem to participate virtually? *
What type of audience will be in attendance? (Select all that apply) *
Required
What is your projected audience size? *
What is your budget for an honorarium/speaker fee (and travel budget if applicable)?  *
Are there other panelists/speakers scheduled (or that you anticipate will be)? Please provide full names. If no other panelists/speakers put "N/A" here *
Please add any additional details you'd like to share about your event or how you'd like to collaborate.  Thank you!
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