HOST ORGANIZATION: *

ORGANIZATION WEBSITE: *

NAME OF EVENT: *

DATE: *

TIME OF PRESENTATION: *

LENGTH OF PRESENTATION: *

DETAILED DESCRIPTION OF WHAT YOU WANT SPEAKER TO ADDRESS: *

ROLE IN EVENT: *

LOCATION + DETAILS: * Indicate whether the event is virtual or in-person, plus url or street address and other details.

TITLE & TYPE OF EVENT: * Provide the name of the event and type (conference or summit, Board meeting, forum, council, other).

AUDIENCE / Attendance: * Indicate the total or estimated number of people you expect to attend or participate in your event.

MEDIA EXPECTED? If yes, please list: *

OTHER SPEAKERS FEATURED (name/title/organization, role, topic): *

PREP/PRE-EVENT CALL: * Indicate the length of time needed for a pre-event prep call.

PRIMARY EVENT CONTACT FIRST NAME: *

PRIMARY EVENT CONTACT LAST NAME: *

EMAIL *

PHONE *

OTHER

AUDIENCE / Other Demographics: * Provide other details about the audience, including sectors (public, private, philanthropic, nonprofit, education), types of leadership present (CEOs, Presidents, Founders, Directors, Managers, Staff), and anything else of note you wish to share.