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ICP Speaker Request Form
1.
Requesting organization
2.
Website or social media URL
3.
Point of contact (name, email, phone)
Name
Company
Email Address
Phone Number
4.
Name of event
5.
Date and time of event
6.
Location of event
Country
City
Time Zone (GMT)
7.
Which ICP speaker are you requesting?
8.
Event type: [summit, conference, workshop, class, town hall, business meeting, free virtual event, etc.]
9.
Anticipated number of attendees:
10.
Speaker format [keynote, roundtable, full panel, panelist among others, small group workshop, large group workshop, webinar, facilitation, emcee, etc]
11.
Length of speaker's request [range: 15 mins to full day]
12.
Primary focus
Climate
Peace
Both
Other (please specify)
13.
What is the theme or purpose of the program?
14.
Platform:
Zoom
WebEx
Google Meets
Skype
Microsoft Teams
In-Person
Other (please specify)
15.
Will this event be livestreamed?
Yes
No
TBD
16.
Will this event be recorded?
Yes
No
TBD
17.
Will this event be advertised?
Yes
No
TBD
18.
Budget for speaker expenses
19.
(if applicable) Please include a link to the event or a flyer/promotional graphic
20.
Anything else that we should know about?
Current Progress,
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