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ERI Speaking Availability Form
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* Indicates required question
Your Name
*
Your answer
Your Organization (if applicable)
Your answer
Email Address
*
Your answer
Phone
*
Your answer
Event Title
Your answer
Event Date (If you do not have a specific date in mind, please list three options that would work for you. If you are a student group, please be aware of your school's academic calendar and avoid breaks and exam weeks.)
*
Your answer
Event Location - City & State
Your answer
Do you have a specific ERI speaker you're requesting?
*
Josh Brahm
Emily Geiger
Rebecca Carlson
No preference
Are you interested in hosting an ERI outreach event in addition to the speaking event?
*
Yes
No
Maybe, I would like to discuss this on a call with an ERI staff person.
Notes/Comments
Your answer
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