Speaker Request Form | STAND - A Student Anti-Genocide Coalition

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Speaker Request Form

Please fill out this form to request help finding a speaker for your event from STAND.

Your First and Last Name: *

Email Address: *

Date of Event*

Location of Event (city / state): *

School Name (if applicable):

Group / Organization hosting the event:

Estimated Size of Audience: *

Type of Audience (age range, level of Darfur involvement, faith group, etc.): *

Is this speaker going to be part of a panel?: *

Yes

No (this is an individual speaking request)

If "Yes", who else will be on the panel?:

Are travel costs covered by the organizer?: *

Yes

Is there an honorarium offered for the speaker?: *

Yes

If "Yes", how much is offered?:

Additional Notes / Details::