Speaker Request Form: Alyse Killeen
Thank you for inquiring about Alyse Killeen's availability to join your Company or Organization’s Event. Please complete this Speaker Form in its entirety, and we will respond to be in contact within forty-eight (48) weekday hours.
Name
Your answer
Organization or Company
Your answer
Email
Your answer
Is your Organization a non-profit?
Name of Event
Your answer
Event Description
Your answer
Date
MM
/
DD
/
YYYY
Event's Address
Your answer
Country and City (State as applicable)
Your answer
Speaking Format
Speaker's Compensation
Travel
Besides the Event's speaking engagement, will other commitments or time be needed from Alyse?
Your answer
Will video be recorded?
Required
How will the Event's presentation footage be used by the Organization or affiliates?
Your answer
Will presentation footage be made directly available to Speakers?
What is the target composition of the audience? (percent of total audience that is women, percent that is black, percent that is Latinx, etc.)
Your answer
What is the target composition of the Event's Speakers? (percent of total speaker group that is women, percent that is black, percent that is Latinx, etc.)
Your answer
Has/Will your Organization implement a Conference Code of Conduct or anti-harassment policy?
Thank You
Thank you for thinking of Alyse for participation in your upcoming Event! Should she be unavailable, we may suggest other speakers from our professional network that have relevant expertise. This Speaker Request Form will be reviewed within two business days of its submission and you will receive a response within that same period. Please note that a 50% non-refundable deposit is required prior to initial engagement (i.e. content development, preparatory calls, etc.), and final payment is required 24 hours before the Event. Invoice and receipt will be generated for your Organization.
Development Resources: Conference Code of Conduct
Many Companies and Organizations have implemented event/conference Code of Conduct or other forms of anti-harassment and inclusion policies in the past several years, or are now beginning the work to do so. For reference and templates to create a Code of Conduct or anti-harassment and inclusion policy, the following resources are some of the best available: a) http://confcodeofconduct.com/, b) http://geekfeminism.wikia.com/index.php?title=Conference_anti-harassment_policy, c) https://adainitiative.org/2014/02/18/howto-design-a-code-of-conduct-for-your-community/
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