Speaker Request Circle Economy
Please fill out this form if you want to request Circle Economy for an event
Email address *
Your Full Name
Your answer
Your Phone Number *
Your answer
Event Name *
Please include link to website
Your answer
Event Location *
Please include the Country, City and Venue where the event taking place
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 *
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
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
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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