ACLU-DC Speaker Request Form
Name
*
First Name
Last Name
Email address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Need-to-know Date (Deadline for decisions)
*
-
Month
-
Day
Year
Date
Name of Event:
*
Enter your answer
Event Type
*
Reception
Meet-and-greet
Panel
Keynote speech
Other
Program Sponsor
*
Enter your answer
Date of Event
*
-
Month
-
Day
Year
Date
Time of Event
*
Enter a time
Event Venue/Address
*
Enter your answer
Estimated audience size and description
*
Is the event open to the public?
*
Yes
No
Issue Areas/Subjects (Select all that may apply)
*
Police practices reform
Criminal justice reform
LGBTQ rights
Reproductive freedom
Free speech and censorship
Freedom of religion
Voting rights
Know Your Rights presentation
Other
Will news media be invited?
*
Yes
No
If yes, specify which:
*
Enter your answer
Other principals (organizations, public leaders, etc.) attending:
*
Enter your answer
What is your event's COVID-19 protocol?
How will the event be publicized?
*
Enter your answer
Will event sponsor assist with costs (e.g., provide honorarium or reimburse expenses)?
*
Enter your answer
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