ZERO TO THREE Speaker Request - Rahil Briggs, PsyD
Your name:
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First Name
Last Name
Your email:
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example@example.com
Your phone number:
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Area Code
Phone Number
Your organization name:
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Your title:
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Event name:
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Event type (please select all that apply):
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Academic conference session
Breakout session
Briefing
Conference (non-academic)
Grand Rounds
Internal presentation
Keynote
Panel
Social media event (Facebook Live, Tweetchat, Instagram Live, etc.)
Training
Webinar
Other
What is ZERO TO THREE's role in the event (please select all that apply):
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ZERO TO THREE is hosting or co-hosting the event
ZERO TO THREE is sponsoring or co-sponsoring the event
A ZERO TO THREE staff member or contractor has committed to speaking/presenting at the event
A ZERO TO THREE staff member or contractor has been invited to speak/present at the event
Other
Event Description (include theme, purpose, desired outcomes/objectives):
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Event date:
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Month
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Day
Year
Date
Start time (Eastern):
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Hour
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10
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40
50
Minutes
AM
PM
AM/PM Option
End time (Eastern):
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Hour
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Minutes
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AM/PM Option
Event Platform and Login Information
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Please provide the speaker login information for the event.
Would you like to schedule a technical dry run or speaker prep call?
Yes
No
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Primary Event Contact Information
Are you the primary event contact for purposes of coordinating ZERO TO THREE's engagement?
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Yes
No
Primary contact name:
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First Name
Last Name
Primary contact organization:
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Primary contact title:
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Primary contact email:
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example@example.com
Primary contact phone number?
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-
Area Code
Phone Number
Is the primary event contact also the day-of contact?
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Yes
No
Day-of event contact name:
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First Name
Last Name
Day-of event contact organization:
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Day-of event contact title:
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Day-of contact email:
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example@example.com
Day-of event contact phone number:
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-
Area Code
Phone Number
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Speaker's Role
Type of presentation:
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Brief remarks
Grand Rounds
Introduction
Lecture
Keynote
Panelist
Other
How much time is allotted for speaker remarks?
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Requested arrival/log-in time for speaker:
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1
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10
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12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Requested themes or topics speaker should address:
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Who will introduce the speaker (name, title, organization)?
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Other invited guest speakers/panelists:
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Will the speaker receive an honorarium? If so, please indicate the amount.
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Audience
Number expected to attend event:
Number expected to attend session:
Description of audience: (Please be as specific as possible e.g., Pre-K teachers, funders, elected officials, etc.):
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Are there notable elected officials, organization leaders, and/or other attendees who we should recognize (include name and title)?
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Media and Promotion
Will there be media outreach for this event? Please select all that apply.
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Event is closed to press
Event is open to press and organizers will do outreach
Event is open to press and ZERO TO THREE will do outreach
Event is open to the press and organizer would like to have a conversation with the ZERO TO THREE media team to coordinate outreach
Event is open to the press, but doesn't require outreach
Press contact name:
First Name
Last Name
Press contact email:
example@example.com
Press contact phone number:
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Area Code
Phone Number
Primary website that will be used to promote this event:
Will the event be live streamed?
Yes
No
What is the live stream link?
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Will the event be recorded?
Yes
No
What social media and hashtags (Twitter, Facebook, etc.) will be used to promote this event?
How else will the event be promoted?
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ZERO TO THREE Collateral
Will the event's host organization share ZERO TO THREE materials with attendees?
Yes
No
What ZERO TO THREE materials will/should be shared at the event?
When must ZERO TO THREE materials be submitted by?
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Month
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Day
Year
Date
Who should receive ZERO TO THREE materials? Please provide contact email or link to upload documents:
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example@example.com
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Other Information
Please upload any relevant documents e.g., agenda, press release, speaker bios, etc.:
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Browse Files
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Is there any other information that would be helpful for us to know?
Do you have any specific requests for the ZERO TO THREE communications team?
Submit
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