Speaking Engagement Form | BlackHealthEdCollab

Presentation & Speaking Engagement Requests

Please fill out the following form.

First and Last Name

Name of Organization/Institution

Your Role

Name of Event/Engagement

Length of speaking engagement

Proposed Topics: Please provide detailed information on the topics you are hoping to cover, including who else will be speaking at the event.

Requested time/timeframe - include timezone (indicate if flexible)

Requested date (indicate if flexible)

Other:

For in-person/hybrid: what is the location?

Budget

Who is your audience? Please include anticipated total number of attendees, type (e.g. staff, leadership, board, internal/external to organization, etc.), and any other relevant information.

Additional Comments

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