Speaker request form - Health Care Without Harm Europe

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

To request a speaker from Health Care Without Harm (HCWH) Europe to participate in your event or webinar, please fill out this short form to provide details about the organiser, the event/webinar, and the requested speaking slot.

A member of the HCWH Europe team will respond to your request.

Organisation name *

Organisation website

Your name *

Your position *

Your email address *

Confirm email address *

Please re-enter your email address

Name of your event/webinar *

Event/webinar website

Event/webinar location *

Please provide the city where your event will take place. Please indicate if it is an online or hybrid event

Event/webinar description *

Please provide a short description of your event

Event/webinar date *

Please indicate the date of the requested speaking slot

YYYY

Event/webinar end date

YYYY

Audience *

Please indicate the expected audience, e.g. healthcare professionals, policy-makers, academia, industry.

Which speaker are you requesting?

Please leave blank if you are not requesting a specific member of the team

Speaking request *

Keynote speech

Panel discussion

Workshop presentation

Moderator

Other:

Session details *

Please provide a short description of the requested speaking slot, e.g. details of other speakers or presentation requirements

Is there a speaker fee available? *

Please enter an amount or n/a

Are travel and accommodation expenses reimbursed? *

Yes

Additional comments or requests

Please include links to supporting documents e.g. agendas, including drafts, if available

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Health Care Without Harm.

Does this form look suspicious? Report

Forms