Speaker & Moderator Details Form

"*" indicates required fields

Please enter your information below.

If you are speaking or moderating in more than one workshop, you must submit this form for each session.

Please reach out to your Alliance workshop organizer(s) with any questions.


Name*


Speaker Pronouns*
Please indicate speaker's pronouns. Multiple pronouns may be indicated in the "Other" box.



Mailing Address



Include the workshop number and title. (i.e. 1.10 Ending Veteran Homelessness)
Please select:*


1000 character limit.

Dietary Restrictions*


Optional Demographic Questions

We are collecting demographic information in order to support our efforts in increasing diversity at our conferences.
Do you consider yourself Hispanic, Latinx, or Spanish origin?

Which of the following five racial designations best describes you? More than one choice is acceptable.

Which of the following most closely represents your gender identity?

Are you currently experiencing or have you in the past experienced homelessness?

Speaker Agreement

This Agreement is made between SPEAKER NAME hereinafter referred to as "Speaker" and National Alliance to End Homelessness, located at 1518 K Street, NW, Second Floor, Washington, DC 20005, hereinafter referred to as "Alliance". The effective date of this Agreement is the date of submission of this form (12/08/2022).

  1. Engagement: Speaker, shall participate in the SESSION NAME
  2. Risk: Speaker shall present the sessions contemplated by this Agreement. Speaker shall indemnify and hold harmless Alliance from any claim, demand, loss, liability, damage or expense arising in any way from the Facilitator’s performance of services.
  3. License for Content archiving/capture/distribution: Speaker grants to Alliance an exclusive license to use Speaker’s presentation and handout materials (collectively “Speaker Property”) in any manner Alliance deems appropriate including, but not limited to, the resale in a Alliance controlled content library, reproduction, distribution, creation of derivative works, and display on the internet of Speaker Property, with Alliance retaining the proceeds derived from such distribution and use of Speaker Property. Speaker also agrees to work directly with the AV company performing these services for Alliance and follow all deadlines to provide PowerPoint presentations, handouts, and recordings that may be associated for content archiving.

By selecting "I agree" below, I agree to comply with all criteria outlined in this agreement. I further acknowledge and consent to Alliance’s use and distribution of my spoken word including newsletter articles, posting of information to the Alliance web site and any supporting materials I have provided. I release Alliance, its officers, employees and agents from any liability that may arise from such use and distribution.

Please select:*

COVID 19 Vaccination Policy

COVID 19 Vaccination Policy*

Code of Conduct*
This field is for validation purposes and should be left unchanged.