Request a Speaker

Name*
First Last
Email*
Phone*
Company/Organization Name*
Date of Event*
Time of Event*

: Hours

Minutes

AM/PM
Description of the Event*
Building Name
Event Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parking Instructions
Speaker Presentation Time

: Hours

Minutes

AM/PM
Expected End Time

: Hours

Minutes

AM/PM
Will this be in-person or virtual?*
- Virtual
- In-person
If it is in person, what policies are in place that the speaker and United Way staff need to be aware of? (Ex. Required to wear a mask)
If it is virtual, what virtual platform will be used? (ex. Microsoft Teams, Zoom)
Wheelchair Accessible
Audience Size
Speaker will be met by/Event contact*
Contact Phone*
Contact Email
Focus Area*

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