Speaking Engagement Inquiry Form
Requestor Information
Contact Name
Email
Phone Number
Information About Requesting Organization
Organization name
Organization website
Organization description
Event Information
Event title
Event description
Event venue or address
Event date
Event start and end times
Desired speaker arrival and departure times
Is this event open to the public?
Yes
No
Anticipated audience size
Describe the anticipated audience
Agenda / schedule available for event?
Yes
No
Agenda / schedule upload
Speaker & Participation Details
Requested speaker (if known)
Requested speaker's participation format (keynote speaker, panel member, etc.)
Speaker's length of time for participation/presentation
Please indicate the subject matter you would prefer the speaker to address during the presentation. (If unknown, say "general Habitat information")
Photo of speaker needed?
Yes
No
Biography of speaker needed?
Yes
No
Are there any audio / video / tech materials that the speaker should bring? If so, please describe.
Habitat Chicago physical collateral/handouts needed
Strategic Plan
Annual Report
Brochures
ReStore Information
Other
If other Habitat Chicago collateral/handouts are needed, please describe.
Is there anything else you would like us to know?
Contact Information