Speaker Request Form

Thank you for requesting a speaker from Voices, the National Coalition Against Domestic Violence (NCADV) Speakers Bureau! Please fill out this form as completely as possible so that the most appropriate match may be made.If you have any questions, please contact Robin Brock at voices@ncadv.org. Please note that, due to sheer volume, we may not be able to meet all requests. Also note that we need a minimum of 6 weeks to locate and secure a speaker.

Please be thorough. You may be contacted for additional information.

Country*
State / Province*
Address*
City*
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Email*
Confirm Email*
Phone*
Event name, date, and time (If you do not include a date, your request cannot be processed)
Detailed event description - Please include topic you would like addressed and/or speaker specific skill set
Venue name and location (full address and closest major city)
Who is the audience? What is the anticipated size of the audience?
How much time will the speaker be given and will there be an opportunity for Q & A?
Will there be a monetary honorarium or reimbursement for travel expenses, lodging, etc?

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