Request a Speaker

Posted February 13th, 2008 by SarahT

To request that Jeffrey Hollender speak at your event, please fill out the form below and include as many details as possible. If you have questions, please contact Lee Pelletier at 802-658-3773 x825.

Fields marked with (*) are required.

Your e-mail address: *

Sponsoring Organization: *

If you marked, "Other," please specify:

Requested Seventh Generation Speaker (if known):

Presentation Information

Presentation Type: *

Speech with Powerpoint

Speech with no Powerpoint

Other

If you marked, "Other," please indicate the speech/presentation type:

Presentation/Speech Topic: *

Presentation/Speech Length: *

Event Information

Title of Event: *

Date and Time: *

Location: *

Conference/Event Background:

Please provide a brief description of the event or conference.

Who is the audience?: *

e.g., executives, decision-makers, industry leaders, students, etc.

Audience Size: *

Are there other invited speakers?: *

Yes

If Yes, please list the names of the speakers, the organization they represent and when they are scheduled to speak::

Additional Information

Will there be media presence?: *

Yes

If yes, please list attending or invited media:

Honorarium/speaking fee available?: *

Yes

Speaker travel expenses covered?: *

Yes

Additional background or information you would like us to know:

Sponsoring Organization Information

Contact Name: *

Contact Phone #: *

Contact E-mail Address: *

Organization Web Site:

Organizaton Address:

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Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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