Healthcare Ocean Speaker Request Form

Speaker Request Form

Healthcare Ocean is a not-for-profit organisation and presentations are undertaken in our own time. We therefore really appreciate financial assistance for travel and accommodation whilst donations help us to continue in our work to improve oceanic and human health.
The title of the event
Event website address
Funding source for the event
Full name of individual making the request

First NameLast Name
Email address of the individual making the request
example@example.com
Date of presentation

DayMonthYear
Date
Start of session time (GMT / BST)

Hour Minutes

AM/PM Option
End of session time (GMT / BST)

Hour Minutes

AM/PM Option
Title or theme of session
Length of presentation required
In personVirtualEither can be accommodated
Expected number of attendees
Is a speaker fee offered?
Is a donation to Healthcare Ocean offered?
Please describe any topics you wish to be covered or specific learning objectives
This next section is only applicable for in person events

Please ignore if your request is for a virtual presentation
Venue address

Building

Street

Town / CityCounty / State / Province

Postal / Zip CodeCountry
Yes, speaker to organise then claimYes, event planner will organiseNo, travel costs are not covered
Yes, speaker to organise then claimYes, event planner will organiseNo, accommodation costs are not covered
Should be Empty:

Speaker Request Form