Speaker Request Form
Use this form to request workshops and speakers from Black Lives Matter - Toronto
Contact Name
Your answer
Organization Name
Your answer
Contact Email Address
Your answer
Alternate Email Address
Your answer
Organization Type
Organizational Purpose/Mission
Your answer
Does your organization primarily serve Black/Afrikan people?
Required
What specifically are you requesting
Required
How many speakers do you require?
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
MM
/
DD
/
YYYY
Is this date flexible?
If so, what are some alternate dates
Your answer
Preferred time
Time
:
Is this time flexible?
If so, what are some alternate times
Your answer
Event location (building name and full address)
Your answer
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