ECWR Speaker Presentation Request Form
Thank you for your interest in booking a speaker presentation with Emerald Coast Wildlife Refuge! If you have any questions while filling out this form, please reach out to ECWR's Educator at emma@emeraldcoastwildliferefuge.org!
This form is for speaker presentations only! If you are requesting a different event, please visit the appropriate tab on the private events website page.
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Contact Information
Once we have received your event request form, we will be in touch with confirmation or clarification of details. Please include the contact information for the point of contact for this event!
Name *
School/Organization *
Address (This is the address that the invoice will be sent to. Please use the following format: Street Address, City, State, Zip Code) *
Presentation Venue Address (If different from above, please use the following format: Street Address, City, State, Zip Code. If the address is the same as above, please write "Same") *
Phone Number (Please indicate if this is a cell phone or landline number!) *
Email Address (This is our primary form of communication - please double check and ensure that the spelling is correct!) *
Event Details
Please answer the following questions to the best of your ability!
Preferred Date(s)
(Reminder: Please submit the speaker presentation request form at least one week in advance for pre-made presentations, and two weeks in advance for special topic request presentations from the earliest requested date. Please include any dates you are available. Our speaker presentations are scheduled around existing events and personnel availability, so the more dates you include the better!)
 *
Preferred Start Time *
Please check the boxes of the grade level(s) that will be present. *
Required
Estimated Total Number of Attendees *
Will there be any special needs participants? If so, what accommodations are suggested?  *
Presentation Details
Does your venue have A/V access for our presenter? *
Topic Request (If you select "Other", please include as much detail about your special topic request as possible. If you select "Other", your presentation will move from Pre-Made pricing to Special Topic pricing.) *
What is your audience's knowledge level on this topic?
How long would you like your presentation to be? (Our pre-made presentations all run very close to 1 hour.) *
How did you hear about ECWR's speaker presentation programs?
Thank you again!
This form will be submitted to Emma, our Conservation & Rehabilitation Educator. If you have any questions, comments, concerns, or wish to make any changes to your form submission, please reach out to her via email: emma@emeraldcoastwildliferefuge.org. You can also contact our Executive Director, Pascal, at director@emeraldcoastwildliferefuge.org!
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