Speaker Request Form

Thank you for your interest in including Alliance staff at your upcoming event. We are happy to be in community with you and want to provide you the best possible speaker. With this in mind, we have created this form to provide us all the relevant information about the event and to connect you with the staff member that can meet your needs. Please take the time to fill out this form and we will get back to you as quickly as possible. If you have any questions, reach out to speaker_request@naeh.org.

Event Information

Which staff member are you requesting for your event?(Required)

What is the name of your event?(Required)

Where is your event located?(Required)

Event Start Date(Required)

Event End Date(Required)

How many sessions do you want the speaker to be a part of throughout the event?(Required)

Is this speaking engagement virtual or in-person?(Required)

Virtual

In Person

This field is hidden when viewing the form

Session 1

Session #1: What are the dates and times of the sessions in which you are requesting an Alliance speaker?

Session 1 Date(Required)

Session 1 Time(Required)

Session 1 Time Zone(Required)

What is the format of the Session 1 speaking engagement?(Required)

If "other", please describe the format of the Session 1 speaking engagement.(Required)

This field is hidden when viewing the form

Session 2

Session #2: What are the dates and times of the sessions in which you are requesting an Alliance speaker?

Session 2 Date(Required)

Session 2 Time(Required)

Session 2 Time Zone(Required)

What is the format of the Session 2 speaking engagement?(Required)

If "other", please describe the format of the Session 2 speaking engagement.(Required)

This field is hidden when viewing the form

Session 3

Session #3: What are the dates and times of the sessions in which you are requesting an Alliance speaker?

Session 3 Date(Required)

Session 3 Time(Required)

Session 3 Time Zone(Required)

What is the format of the Session 3 speaking engagement?(Required)

If "other", please describe the format of the Session 3 speaking engagement.(Required)

This field is hidden when viewing the form

Additional Sessions

Please provide the date, time, and format of each additional session beyond the 3 listed above.(Required)

This field is hidden when viewing the form

Section Break

Additional Event Information

What are the topics you would like our staff to cover?(Required)

Which general section of the Alliance work does this topic most align with? Check all that apply.(Required)

Federal, State, or Local Policy

Research

Technical Assistance

Communications/Messaging

Other

Other (Please Specify)(Required)

How many people do you expect to attend your event?(Required)

Approximately how many people do you expect to attend the session(s) in which Alliance staff would be speakers?(Required)

What expenses, if any, are you able to cover?

The Alliance has a commitment to partnering with people who have lived expertise. This ensures policy and program design decisions are well informed. To put this commitment into practice, we ask all speaker requests to show how they are committing their event to the same efforts.

How are you including people with lived expertise in your event agenda? Please provide details.(Required)

Contact Information

Name(Required)

First Last

Email(Required)

Phone(Required)

Job Title / Affiliation with the Alliance(Required)

Organization(Required)