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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