Speaker's Bureau Request Form
Thank you for your interest in bringing a torture survivor or family member to share their story with your community or organization! Please read the following policy and procedure carefully, as it contains important details about how to ensure the booking process is as easy and efficient as possible. Once you provide your electronic signature at the bottom to show you've read the policy in its entirety, you will be asked for details about your planned speaking engagement!
Speaker's Bureau Request Policy:
1) This online form is the primary and best way to schedule a survivor or family member to come speak at your event! We will respond to each request within three business days.

2) If you would like to request a survivor or family member to come speak, please allow at least two weeks advance notice before the date you’d like them to come! If this is not possible, we will still try to accommodate, but can't guarantee a speaker will be available for your requested date.

3) Please direct all communication about schedule changes or requests to the Center in order to ensure that the scheduling process is as efficient and easy as possible. Please do not contact speakers directly with scheduling requests or changes!

4) We charge a $200 speaker's fee - $150 goes directly to the speaker, and the remainder goes to the Center to cover costs associated with processing your request. If your organization is unable to pay some or all of this amount, please indicate this on the request form and provide some detail about your need. If you are a well-resourced organization, we ask that you pay the full amount so that we can save our small subsidy for organizations with higher need.

5) If you are requesting a speaker for multiple times on the same day, we ask that the break in-between engagements be no longer than 30 minutes. If the break is longer than 30 minutes, we ask that you complete another request form and pay an additional speaker's fee.
I have read and understood the above policies and procedures (please sign your name): *
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Chicago Torture Justice Center.