SPEAKER REQUEST FORM
To request an AANBNA member to speak at your event, please complete this forn:
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Email *
Name of Event *
Event Dare *
Event Location *
Event Format (In-person, Virtual, Hybrid)
 *
Expected Audience Size
 *
Event Organizer (Organization/Company)
 *
Contact Person Name/Title
 *
Contact Phone Number
 *
Contact Email Address
 *
Event Website/Social Media
 *
Requested Topic(s) for Discussion
 *
Type of Engagement (Keynote, Panel Discussion, Workshop, etc.)
 *
Audience Demographics (e.g., industry professionals, students, general public)
 *
By submitting this form, I acknowledge that I am authorized to make this request on behalf of my organization. I understand that submitting this form does not guarantee the participation of the requested speakers, and that all details are subject to further discussion and agreement.
 *
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