Speaking Engagement Form
Please complete to request a speaker from Backyard Basecamp
Contact Name and Title *
Email Address *
Phone *
Organization Name *
Does your organization have a website? Please share it here
Type of Organization *
Does your organization have any social media accounts? Please share them here
Date of Event *
MM
/
DD
/
YYYY
Speakers Start Time *
Time
:
Speakers End Time *
Time
:
Type of speaking engagement *
Location of Event (if this event is online only, respond as “Virtual”) *
Do you intend to record this speaking opportunity *
Please tell us what you and the the other participants hope to learn from representatives of Backyard Basecamp, Inc *
Whom from Backyard Basecamp, Inc. would you like to host as your speaker? *
Required
Estimated Number of Registrants *
Are there any relevant demographics pertaining to your audience members that you would like to share with us?
Are you offering an honorarium for speakers? If so, what is the budget for this event? *
Are you willing to cover travel expenses, if needed? *
Are there any special considerations or notes that we may need to know about this presentation that have not been covered already?
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