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Speaker Request Circle Economy
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* Required
Email
*
Your email
Your answer
Your phone number
*
Your answer
Name of event
*
Your answer
Website of the event
*
Your answer
Event Location
*
Please include the Country, City and Venue where the event taking place
Your answer
Event Organiser
*
Name of the organisation behind the event
Your answer
Event Description
*
Please provide a short description of your event
Your answer
Event Starting Date
*
This is the date of the requested speaking slot
MM
/
DD
/
YYYY
Event Ending Date
MM
/
DD
/
YYYY
Topic of Requested Speaking Slot
*
Your answer
Type of Request
*
Choose
Keynote Speech
Workshop
Breakout Session
Panel Discussion
Other
Please add a short description of the session
*
Who are the other speakers joining? Are there any powerpoint requirements? Etc.
Your answer
Which Circle Economy Speaker are you requesting?
Leave blank if you are not requesting a specific person
Your answer
Audience
*
Please specify the type of audience you are expecting to attend the event
Your answer
Audience Size
*
< 20
20 - 50
50 - 100
100 - 200
> 200
Total Participants
< 20
20 - 50
50 - 100
100 - 200
> 200
Total Participants
Are travel and accommodation expenses for the speaker reimbursed?
*
N.B. Circle Economy requires expenses to be covered when the speaking request involves international travel
Yes
No
Is there a speaker fee available?
*
Yes
No
If the speaker fee is available, please specify the amount (type in "n/a" if not applicable)
*
Your answer
Do you have any additional notes?
Your answer
A copy of your responses will be emailed to the address you provided.
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