Request Emerald Garner for Your Event 

We are grateful for your interest in booking Emerald Garner. To move forward with your request, please complete and submit the form below. Ms. Garner is dedicated to inspiring individuals by recounting her personal journey of turning Anger Into Action. 

Thank you for your interest, and we are eager about the potential collaboration with you.

Sign in to Google to save your progress. Learn more
Email *
Please List Co-Panelist (Panel Request only)
Will meals be provided? *
Event Date *
MM
/
DD
/
YYYY
First and Last Name  *
If Yes Please provide links and/or social media handles *

When can we meet for a discussion?

*
MM
/
DD
/
YYYY
Organization Mission *
Lenghth of time for speaker's presentation *
Event Name  *
Event Start Time *
Time
:
Will there be press at the event? *
Organization Name  *
Please indicate your budget below *
Please provide security precautions you have in place for this event *

Please provide the date when confirmation is needed

*
MM
/
DD
/
YYYY
Please List Co-Sponsors, if any. *

Could you please provide a list of the upcoming dates and times when you are available to meet with the team?

*

Please provide the details for travel and location below, including car service, flights, and hotel arrangements if applicable.

*

Speaker Type Requested

*
Required
Event Location- City, State, and Zip *
How many attendees do you anticipate attending your event? *
Topic of Discussion or Event  *
Will this event be streamed or recorded? *
Event End Time  *
Title *
Organization Website *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of We Can't Breathe.

Does this form look suspicious? Report