Speaker Request Form
Please share as much information as possible to help us serve your needs. We will consider requests made at least 4 weeks in advance. If your event is sooner, please either consider a later date or consult the resources made available to you on the UP website.

(By submitting this form, you are granting: Upstander Project, 25 Haverford Street, Boston, Massachusetts, 02130, United States, http://upstanderproject.org permission to email you. You may unsubscribe via the link found at the bottom of every email. See our Email Privacy Policy for details: https://www.constantcontact.com/legal/privacy-notice. Emails are serviced by Constant Contact.)
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Organization Name
Organization Type *
Required
Phone number
City
State/Province
Zipcode *
Is this speaker invited via video or in-person? (choose the most likely scenario) *
Which film(s) would you like to screen (check all that apply) *
Required
Have you completed your purchase or booking of the film? *
Have you or your organization organized a successful film screening previously? *
Do you know which speaker(s) you would like to join you? (You may check multiple people)
Ideal date for speaker to attend your screening (present - 2023) *
~if unsure, provide your best estimate~
MM
/
DD
/
YYYY
Ideal time for speaker to attend your screening (please include start and end time) *
~if unsure, provide your best estimate~
Any additional info about ideal date? (i.e. is your date firm or flexible?)
Estimated Audience Size
Clear selection
Do you have a budget to provide honoraria for speakers? Please share as many details as possible. *
Are you working with any partner organizations you would like to mention? (please list names)
Anything else you want us to know about your screening plans?
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy