Speaker Request Form

Speaker Requested
Name*
First Last
Email*
Organization/Company*
Tell us more about your organization
Website
Phone
Date of Event
MM slash DD slash YYYY
Start Time

: Hours

Minutes

AM/PM
End Time

: Hours

Minutes

AM/PM
Event Type
In-Person or Virtual?
- In-Person
- Virtual
- TBD
Event Description
Audience Demographics
Expected number of attendees
Desired presentation length
Honorarium
Thank you for valuing the intentional effort and hard work of our team. Will an honorarium be provided to support the mission of Dallas TRHT?
- Yes
- No
Is your event a part of a fundraiser?
- Yes
- No
Media coverage expected?
Other speakers/invitees

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