The Centre for Sustainable Healthcare Speaker Request Form
Please complete this form with details about your event and your requirements for a CSH speaker. Please send it to us no later than 6 – 8 weeks before the event. We aim to respond within 14 days of receiving the request but during busier times this may be a little longer.
Event Title
Organisation
Contact name
Email
example@example.com
Have you already had a discussion with a CSH staff member about this request?
Please Select
Yes
No
If yes, please let us know who?
Back
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Event details
Date of the event:
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Start and end time of the event
Hour Minutes
Until
until
Hour Minutes
Who is the audience and how many are you expecting?
Please give a brief overview of your request: What is the aim of the event. What is required from a CSH speaker?
*
0/200
Is the request for a speaker in person or online?
*
Please Select
Online only
In person only
Either
Additional info
Location of the event
Can you offer a speaker fee?
Are you able to provide renumeration for travel costs and accommodation if necessary?
Submit
Should be Empty: