Tell me more about your event Name * First Name Last Name Email * Phone (###) ### #### Is it okay to leave voicemails at this number? * Yes No Will you be the primary contact person on the day of the event? * Yes No If no, please provide the name and number of the primary contact person on the day of the event. Your organization name * Name/Title of your event * When will your event take place (date & time)? * Location of your event (if virtual, please specify here) * Expected number of attendees * Age group of attendees (i.e., children, teens, adults, etc.) * Are you charging attendees a fee to attend this event? If yes, how much per person? * Preferred method of presentation (select all that apply): * Lecture (a powerpoint presentation with Q&A at the end) Workshop (presentation with group activities and open dialogue/discussion throughout) Individual interview (I answer pre-approved questions in an interview style) Panel interview (I participate on a panel in which I and others answer questions asked by a facilitator) Expected length of presentation * Topics you would like to be covered in the presentation (please be as specific as possible) * Would you like handouts to be provided at this presentation? * Yes No Will the event be recorded, broadcast, or streamed? * Yes No Will your organization be providing equipment for this presentation (i.e., projector, screen, microphone, podium, speakers)? * Yes No N/A What is your organization's budget for this presentation? * Is there anything else you would like to share about your event or any special instructions you would like to provide? Thank you!
