GIP Speaker Request Form
Please fill out this form to request a Georgia Innocence Project staff or exoneree speaker for your event.
Sign in to Google to save your progress. Learn more
Name of group or institution *
Website of group or institution *
Your name *
Your title *
Your email address *
Your phone number
Location of speaking engagement *
Date and time of speaking engagement *
If you are considering a number of possible dates and haven’t chosen one yet, please include all possible dates
Format and length of speaking engagement
For example, indicate whether it’s a single­ speaker format or a panel, and indicate if you have a preference for how much of the time will be spent on presentation and how much on questions and answers.
What kind of speaker would you like? *
Please provide any other relevant details as it pertains to your request *
For example, theme of conference, willingness to provide honorarium, etc.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Georgia Innocence Project. Report Abuse