Speaker Request Form
Use this form to request workshops and speakers from Black Lives Matter - Toronto
*Required
Contact Name
*
Your answer
Organization Name
*
Your answer
Contact Email Address
*
Your answer
Alternate Email Address
Your answer
Organization Type
*
Choose
Community organization
University/college class
University/college club/student group
Labour union
Student union
Hospital/clinic/health advocacy org
Elementary/middle/high school
NGO
Other
Organizational Purpose/Mission
*
Your answer
Does your organization primarily serve Black/Afrikan people?
*
Yes
No
Required
What specifically are you requesting
*
Keynote presentation
Panel presentation
Workshop presentation
Greetings/solidarity statement
Rally/protest speaker
Other:
Required
How many speakers do you require?
*
1
2
3
4
5
Please provide a brief description of your event, and why you would like us to be present.
*
e.g.: This is a film screening of Movie A. We hope for you to introduce the film and be present for a panel discussion after the film.
Your answer
Describe the audience
*
Your answer
Preferred date
*
Date
Is this date flexible?
*
Yes
No
If so, what are some alternate dates
Your answer
Preferred time
*
Time
:
Is this time flexible?
*
Yes
No
If so, what are some alternate times
Your answer
Event location (building name and full address)
*
Your answer
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