Dare 2 Share (D2S) Speaker/Trainer Request Form
Event Name
:
Date(s)?
Contact Name
Phone:
Email:
Website:
Is this a virtual event?
Yes
No
What Language?
English
Spanish
Venue Name:
Venue Address:
Venue City:
State:
Zip Code:
What platform will you be using?
Host Time Zone:
What Kind of Event is this? (Click all that apply)
Speaking
Workshop
Training
Breakout
Network
International
Event Objective:
Total Expected Attendance:
Total Expected Youth Leaders:
Total Expected Students:
Who would you like to speak at your event?
Ben Phillips
Gustavo Gonzalez
Jason Lamb
Tony Kohler
No Preference
Financial Considerations
SPEAKERS CONSIDERATION:
(Please check boxes)
Event is covering travel and all related expenses
Yes
No
Event is able to pay an honorarium
Yes
No
Contract Information
If approved, we will send a contract to follow that must be signed and dated.
The completion of this form does not confirm any agreements or contracts.
Questions/Notes:
Contact Information