Oasis House Speaker Request Form
Please fill out the form below if you are requesting a speaker for your event. We would appreciate you make every effort to fill out the form 30 days prior to your event. Requests for events with less than 30 days notice may not be guaranteed. We will be get back with you shortly once the form is submitted.
Contact Information
Organizational Name
Contact Person
First Name
Last Name
Contact Phone Number
-
Area Code
Phone Number
Contact Email
example@example.com
Event Details
Event Title
Event Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Description of Event
Event Date
-
Month
-
Day
Year
Date
Event Start Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Event End Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Expected Audience Size
0-10
10-30
30-50
50+
Will this event be videotaped?
Yes
No
Budget for Speaker Honorarium
Presentation Details
Length of Requested Presentation
PowerPoint requested
Yes
No
Media Equipment Available
Computer
Projector
Cables
Other
Presentation Requested
Oasis House Info
Sex Trafficking
Other
Additional details for event?
Submit
Should be Empty: