Request a Speaker

Need to inspire others about environmental sustainability? Looking for a Green representative to speak at your event? Complete this form to submit your request. Please permit up to two (2) weeks for a response.

Organisation name *

Contact Name *

Contact Name

First Name

Last Name

Contact Email Address *

Contact Number

(###)

###

####

Event Address *

Event Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Event Date *

Event Date

YYYY

Event Time *

Event Time

Hour

Minute

Second

Time Commitment *

Audience Size *

Audience Profile *

Event Focus *

Request Type *

Travel Expenses Provided *

None

Air/Train Travel

Hotel

Honarium / Guest Offering

A/V Equipment Available *

Projector

DVD Player

Screen

Speakers

None

Do you need the Speaker's Bio? *

Do you need the Speaker's Picture? *

Will Press be present?

Additional Information