Speaker Request Form
You are filling out this form because you would like to invite a Ve'ahavta Speakers Bureau graduate to come and share their story with your group. This form will help us to determine who to schedule for this speaking engagement. We will be in touch shortly to let you know speaker details. Thank you!
Organization name:
Your answer
Full name of contact person:
Your answer
Contact phone number:
Your answer
Contact email address:
Your answer
Have you hosted a tikun workshop or Ve'ahavta speaker before?
What motivated you/your organization to invite a Ve'ahavta speaker with lived experience to speak with your group?
Your answer
What date are you requesting for the speaking engagement?
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Arrival time:
Time
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Start time:
Time
:
End time:
Time
:
What is the venue? Please provide name of venue and address, and any details about a specific entrance or security considerations:
Your answer
Is there parking available for staff?
Your answer
Size of group:
Your answer
Please describe the audience demographics (nature of school, camp or workplace, group dynamics, coed or not, familiarity with Ve'ahavta, familiarity with social justice work, etc):
Your answer
Content expectations for speaker to consider:
Your answer
Need speaker confirmation by:
Your answer
What other programs would you be interested in doing with us?
Is there anything else we should know about the request?
Your answer
To whom should the invoice be addressed? Please provide name and title:
Your answer
Thank you!
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