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Embrace Boston Speaking Engagement Request Form
Please complete the fields below that apply to your event. For all others, please write N/A.
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Who would you like to speak at your event?  *
What is the desired length and focus of the remarks?
 *
What is the nature of the engagement? (Check all that apply)
 *
Required
Is this an in-person or virtual event?
 *
Who is the event(s) sponsor or sponsoring organization? Please list all
 *
What is the date of the event?
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MM
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DD
/
YYYY
What is the start time of the event?
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Time
:
What time should the presenter(s) arrive? 
 *
Please enter the name and address of the event venue.
 *
Please provide a brief event description and a link to the event's promotional website (if available).
 *
Who is in the audience? (e.g. - community partners, young people, donors, award recipients etc.)
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What is the anticipated number of attendees?
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What would the role of Embrace Boston's representative be at the event?
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Please indicate the amount of the honorarium being offered.
 *
If available, please provide the names of any other speakers, panelists or individuals expected to attend that you want us to be aware of. 
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Is the event going to be recorded or broadcast live? *
If this request requires out of state travel, what is the travel budget? *
Please provide the name, email, and phone number of the event contact at the sponsoring organization: 
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Please describe how this event connects to Embrace Boston's work:
 *
What else will you need in advance of the meeting? (e.g. - pre-meeting with the organizers, head shot, bio, other)
 *
Your Name: 
 *
Your email address:
 *
Your contact phone number *
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