Speaker Request Circle Economy
Email address *
Your phone number *
Name of event *
Website of the event *
Event Location *
Please include the Country, City and Venue where the event taking place
Event Organiser *
Name of the organisation behind the event
Event Description *
Please provide a short description of your event
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 *
Type of Request *
Please add a short description of the session *
Who are the other speakers joining? Are there any powerpoint requirements? Etc.
Which Circle Economy Speaker are you requesting?
Leave blank if you are not requesting a specific person
Audience *
Please specify the type of audience you are expecting to attend the event
Audience Size *
< 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
Is there a speaker fee available? *
If the speaker fee is available, please specify the amount (type in "n/a" if not applicable) *
Do you have any additional notes?
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Circle Economy. Report Abuse