ICP Speaker Request Form

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* 1. Requesting organization

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* 2. Website or social media URL

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* 3. Point of contact (name, email, phone)

Name

Company

Email Address

Phone Number

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* 4. Name of event

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* 5. Date and time of event

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* 6. Location of event

Country

City

Time Zone (GMT)

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* 7. Which ICP speaker are you requesting?

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* 8. Event type: [summit, conference, workshop, class, town hall, business meeting, free virtual event, etc.]

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* 9. Anticipated number of attendees:

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* 10. Speaker format [keynote, roundtable, full panel, panelist among others, small group workshop, large group workshop, webinar, facilitation, emcee, etc]

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* 11. Length of speaker's request [range: 15 mins to full day]

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* 12. Primary focus

Climate

Peace

Both

Other (please specify)

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* 13. What is the theme or purpose of the program?

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* 14. Platform:

Zoom

WebEx

Google Meets

Skype

Microsoft Teams

In-Person

Other (please specify)

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* 15. Will this event be livestreamed?

Yes

TBD

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* 16. Will this event be recorded?

Yes

TBD

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* 17. Will this event be advertised?

Yes

TBD

ICP Speaker Request Form

Question Title

* 1. Requesting organization

Question Title

* 2. Website or social media URL

Question Title

* 3. Point of contact (name, email, phone)

Question Title

* 4. Name of event

Question Title

* 5. Date and time of event

Question Title

* 6. Location of event

Question Title

* 7. Which ICP speaker are you requesting?

Question Title

* 8. Event type: [summit, conference, workshop, class, town hall, business meeting, free virtual event, etc.]

Question Title

* 9. Anticipated number of attendees:

Question Title

* 10. Speaker format [keynote, roundtable, full panel, panelist among others, small group workshop, large group workshop, webinar, facilitation, emcee, etc]

Question Title

* 11. Length of speaker's request [range: 15 mins to full day]

Question Title

* 12. Primary focus

Question Title

* 13. What is the theme or purpose of the program?

Question Title

* 14. Platform:

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* 15. Will this event be livestreamed?

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* 16. Will this event be recorded?

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* 17. Will this event be advertised?

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* 18. Budget for speaker expenses

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* 19. (if applicable) Please include a link to the event or a flyer/promotional graphic

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* 20. Anything else that we should know about?