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)

Name

Company

Email Address

Phone Number

Question Title

4. Name of event

Question Title

5. Date and time of event

Question Title

6. Location of event

Country

City

Time Zone (GMT)

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

Climate

Peace

Both

Other (please specify)

Question Title

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

Question Title

14. Platform:

Zoom

WebEx

Google Meets

Skype

Microsoft Teams

In-Person

Other (please specify)

Question Title

15. Will this event be livestreamed?

Yes

TBD

Question Title

16. Will this event be recorded?

Yes

TBD

Question Title

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:

Question Title

* 15. Will this event be livestreamed?

Question Title

* 16. Will this event be recorded?

Question Title

* 17. Will this event be advertised?

Question Title

* 18. Budget for speaker expenses

Question Title

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

Question Title

* 20. Anything else that we should know about?

1. Requesting organization

2. Website or social media URL

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

4. Name of event

5. Date and time of event

6. Location of event

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

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

14. Platform:

15. Will this event be livestreamed?

16. Will this event be recorded?

17. Will this event be advertised?

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?