Equality for All Speaking Engagement Request Form Question Title * 1. Organisational Details Requesting Organisation Key Contact Person Email Address Phone Number Question Title * 2. Event Details Name Date Timeframe Location Question Title * 3. Which Equality Advocate would you like to hear from? Select up to 3 options. Please click HERE for Equality Advocate Bios. (Required.) Alison Annabel Bernie Brenda Christine Feonyx Jessie Joy Katrina T. Leena Lili Modupe Sreelekshmi Question Title * 4. Which presentation topic are you requesting? (Required.) Accessing employment Accessing health care services Accessing leadership opportunities Accessing sexual and reproductive health services Chronic illness Gender and disaster Mental health Participating in sports Volunteering for organisations Workplace inclusion and belonging Other (please specify) Question Title * 5. Speech Details Proposed speech length in time Will there be a Q&A session? Target audience Estimated audience size Our Equality Advocates talk about a range of topics including gender inequality and discrimination, please be aware of this in your preparation and communicate with event attendees. FURTHER DETAILS Question Title * 6. Role of Equality Advocate at Event Key Note Guest Speaker Panellist Breakout Sesssion Other (please specify) Question Title * 7. Mode of Delivery Webinar In-person Other (please specify) Question Title * 8. Will the media be contacted? Yes No Question Title * 9. Type of Media Newspaper Radio TV Other (please specify) None of the above Done