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HW4P Speaker Request Form 
Thank you for reaching out to us to speak on behalf of Palestinian health workers. Please fill the request form so we can respond as soon as possible. If you are media please complete the media request form. 
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Please advise the proposed date. This helps us to respond to the most time sensitive requests expediently.  *
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Please advised the proposed time, include time zone.  *
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Do you have a specific speaker in mind?
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Is this an online or in person event? 
Please advise location
If you know who the other speakers will be from other organisations etc., please advise who else will officially be attending. 
If this is a fundraiser please advise who you will be fundraising for. 
Please advise briefly what subjects you would like covered by the speaker. 
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