Equality for All Speaking Engagement Request Form Speaking Engagement Request Form Question Title * 1. Organisational Details Requesting Organisation Key Contact Person 1 Key Contact Person 2 Address City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 2. Event Details Event Name Event Date Event start time Event finish time Event location Question Title * 3. How many Equality Advocates would you like to invite? Question Title * 4. Which Equality Advocates would you like to hear from? (Please select 3 options so we can confirm availability) Please click here for Equality Advocate Bios Alison Annabel Brenda Christine Heidi Leena Lili Modupe Vanessa Question Title * 5. Which presentation topic are you requesting? Access to employment Workplace inclusion and belonging Access to leadership positions Access to health care services Access to sexual and reproductive health services Participating in sport/community organisations Other (please specify) Question Title * 6. 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 * 7. Role of Equality Advocate at Event Key Note Guest Speaker Panellist Breakout Sesssion Other (please specify) Question Title * 8. Technology Zoom Webinar Other (please specify) Question Title * 9. Will the media be contacted? Yes No Question Title * 10. Type of Media Newspaper Radio TV Other (please specify) None of the above Question Title * 11. Any further relevant information? Done