Women Speakers in Healthcare: Speaker Request form
Please use this form to contact us if you would like us to help you source a woman speaker for your healthcare event.

** PLEASE NOTE - at least SIX WEEKS NOTICE in advance of an event is recommended to alllow the best chance of finding a speaker. We are happy to accept last minute requests and will always endeavour to help, but be aware that many of our speakers work on-call rotas, so may not be available at short notice.

Filling in this form does not guarantee that we will identify a speaker to fulfil your requirements, however we will search our extensive database and make all reasonable efforts to connect you with a suitable speaker.

All further arrangements must take place between you, the conference organiser, and the individual that you select as your preferred speaker.

All views are the speaker's own and do not represent the views of WSH.
Email address *
Contact name
Your answer
What is the event you require a woman speaker for?
Your answer
Date of event
MM
/
DD
/
YYYY
Location of event
Your answer
Is the venue fully accessible for those with additional mobility needs?
Your answer
Are there childcare facilities available at the event?
Type of speaker engagement
Topic / theme speaker required to speak about
Your answer
What are the intended learning outcomes for the audience?
Your answer
Audience (how many in attendance, which professions represented, what level of training)
Your answer
Time of speaker slot (if flexible, answer in next question)
Time
:
Timing can be flexible around speaker's personal committments (please give details)
Your answer
Length of speaking slot
Your answer
WSH believe that 'free time' is not free! How will the speaker be compensated for their time - is there a speaker fee, travel and accommodation funding, free conference registration, or any other compensation available? (We realise that small organisations may not be able to meet these suggestions - please be open about your circumstances)
Your answer
Thank you for filling in this form. We will be in touch as soon as possible. If you have any further questions please email us - womenspeakershc@gmail.com
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy