Speaking, Events or Training Request
Thank you for connecting with Erin Brown Connects, Disabiltiy Advocacy and Inclusion Management, please complete this form to assist us in responding to you in a timely fashion.
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Email *
Date of Event *
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Time Requested *
Time
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Location: *
Type of request . Select all that applies ; *
Required
Desired Virtual Platform *
Do you currently use an unlimited virtual platfrom account ? *
If yes, Please check all that apply.  The assigned virtual platfrom provides the following :
If no, please advise if one will be provided or is being requested for this event? *
Target Number of Participants *
Targeted Area *
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Please provide the estimated precentage of males and females *
Please select the estimaged age ranges. Select all that apply. *
Required
Targeted Audience. Please select all that apply *
Required
Identify two areas that need immediate attention *
Please provide your budget or honorarium amount for the request. *
Do you currently have participants who self identify with a disability ?  If yes, please provide the types of disabilities. *
Are there any specific need accomodations or request required for the request? *
Would you like a digital workbook or resources for participants ? *
Will the event be recorded for reuse ? *
Please provide social media handles ( Facebook, Instagram, Twitter, LinkedIn ) and or website. if applicable;
Would you be interested in upcoming or continuing education trainings or programs in Diversity, Equity and Disability Inclusion ? *
I understand that payment will be provided by direct deposit or cheque  no later than seven days after requested event. Unless *otherwise stated. *
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A copy of your responses will be emailed to the address you provided.
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