Equality Florida Speaker Requests

Equality Florida Speaker Requests

Please complete as much information as you have about your event and speaker requirement.

Contact Information

Sponsoring Organization

Contact Name

Contact Position

Contact Phone Number

Contact Email*

Street Address

Address Line 2

City

State

Select

Zip Code

Website

Purpose of Program

Are you willing to cover our travel expenses and room accommodations? **

Select

Is there funding available to cover an honorarium? **

Select

Please Describe Your Event/Program

Date of Program

Time of Program

Location of Program

Name of Program

What is the Theme/Purpose of the Program:

Requested Speaker (if you are interested in a particular speaker):

Proposed Topic

Time of Speakers Presentation

Length of Presentation

Presentation Format (panel, speech, roundtable, etc.)

How will this event be promoted?*

Approximate Size of Expected Audience

Will this event be videotaped?

Due Date for Written Materials & Biography

Email address where written materials & biography

Additional Information

Send me a copy of my responses