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English (US)
To request the participation of Dolores Huerta, or another person affiliated with the Dolores Huerta Foundation at your event, please fill out the following information.
At 93, Dolores continues to be very active. She is in high demand and her schedule fills up quickly. If you are requesting Dolores for an event that is less than 2 months in the future, it is unlikely that she will be available to attend.
Contact Information
Name of Organization/Individual Hosting Event
*
Event Contact Person's Name
*
First Name
Last Name
Event Contact Person's Title
*
Event Contacts Person's Cell Phone
*
Event Contact Person's Email
*
Event Information
Please complete this form to the best of your ability. If any information is missing, we will ask you to return and complete it.
Proposed Event Date
*
/
Month
/
Day
Year
Proposed Event Date
*
Title of the event
*
Event Description
*
Do you want the speaker to be present in person or virtually?
*
Virtual Event
In Person Event
Type of Event
*
Please Select
Speaking Engagement/Keynote Speaker
Protest/Demonstration/March
Reception or Dinner
Attendee/Guest
Awardee
Panelist
Fundraiser for the Hosting Organization
Is the event private or public?
*
Public
Private
Location of the Event
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Is your event an indoor or outdoor event?
*
Outdoor Event
Indoor Event
Which type of platform will you use to hold your event?
*
Zoom
Google Meets
Microsoft Teams
Cisco Webex
BlueJeans
RingCentral
Facebook
Instagram Live
Skype
Other
What COVID 19 prevention protocols will be in place?
*
Who is the event's intended audience?
*
Ex: Students, Community Members, Staff, Faculty
What is the expected attendance ?
*
How many people do you expect to attend the event?
Please list any dignitaries and/or VIP's who have been invited, or confirmed, to participate at this event?
Speaker Information
Please keep in mind that we are in pacific time.
Time Requesting Speaker
*
AM
PM
AM/PM Option
to
until
AM
PM
AM/PM Option
Total 0.0
Event Time Zone
*
Please Select
PT (Pacific Time)
MT (Mountain Time)
CT (Central Time)
ET (Eastern Time)
Describe the topic or theme you'd like the speaker to cover.
*
Who are you requesting to speak/attend at your event?
*
Dolores Huerta
DHF Staff Member
Family Member(s) of Dolores Huerta
DHF Board Member
Other
If Dolores is unable to attend, would you be interested in hosting another DHF speaker?
*
Yes
No
Additional Note or Comments:
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At 92, Dolores works as a full time volunteer for the Dolores Huerta Foundation and does not receive a salary. She donates more than 95% of the income she receives for her appearances to DHF. Please consider paying Dolores a fee for her appearance at your event. The Dolores Huerta Foundation relies on these funds to carry on its community organizing efforts.
We require a speakers fee/honorarium to be paid to the Dolores Huerta Foundation in return for the speaker's time. Please confirm.
*
Yes
No
Is your organization willing to host a fundraiser for the Dolores Huerta Foundation if there is no honorarium or speakers fee?
*
Yes
No
Please confirm the honorarium/speakers fee amount?
*
Would you agree to give the Dolores Huerta Foundation a table for merchandise and information?
*
Yes
No
We require that Dolores' and a traveling companion's travel and accommodation expenses be covered. Please confirm.
*
Yes
No
Dolores is paid $25,000 for speaking engagements in California and $30,000 for speaking engagements outside of California, plus travel and lodging for her and a travel partner.
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