Speaker Request Form

Host/Host Organization*

Name of IS staff member invited to speak

First NameLast Name

Is the host organization an Independent Sector member?*

YesNo

Host organization point of contact name*

First NameLast Name

Point of contact title

Point of contact email*

example@example.com

Name of event or speaking opportunity*

Event/Opportunity description*

Be sure to include what kind of opportunity this is: moderator, panelist, keynote, etc.

Event/opportunity (start) date

Date

If this is a multi-day event or if you're requesting multiple activities, explain here.

Event/opportunity start time (time at which the IS staff member needs to be available)

Hour Minutes

AM/PM Option

Event/opportunity end date

Date

Event/opportunity end time (time at which the IS staff member would be released)

Hour Minutes

AM/PM Option

Is this request...*

In-personVirtualBoth are options--TBD

Event location address (for in-person opportunities)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Event website, if applicable

Communications contact for the event

First NameLast Name

Communications contact email address

example@example.com

Date by which you need a response from IS regarding this invitation*

Date

What is the estimated size of the audience for this event/opportunity?*

Who is the anticipated audience for this event/opportunity?*

Helpful examples include: nonprofit leaders, general nonprofit sector audience, philanthropy, business group, racial justice, youth focused, housing, state association, etc.

What topic/s do you hope an IS speaker will cover? *

Please be as specific as possible.

Who else is being invited to speak alongside the IS speaker at this event/session?

Please offer names, titles, orgs, areas of expertise, etc.

In what ways does the event/speaker line-up maximize diversity of perspectives in terms of race, ethnicity, gender, age, and sexual orientation? *

Please be as specific as possible.

Please describe how you envision speaker prep. What do you intend to provide? What prep is expected from IS? Do you need IS communications staff to participate in prep/prep meetings?

If there will be travel or other expenses connected to this opportunity, how will these arrangements and expenses be coordinated and managed? Please include any necessary names/contact information.

If there is an honorarium offered for this opportunity, please indicate the amount below (if not offered, indicate 0). *

Please describe any envisioned social media strategies for this event/opportunity.

For example, is there a hashtag

Will the speaking engagement be broadcast or streamed in any way? If so, please describe.

Is there any opportunity to promote IS at this event? If so, please provide any materials you need from the IS communications/marketing team.

Please feel free to offer any other details or supporting information that will help clarify this opportunity.