Speaker Request Form

If you’d like an Upstream thought leader to speak at an upcoming event, please fill out the form below and someone will reply to you promptly.

Name

First Name

Last Name

Organization

Who would you like to speak at your event?

What prompted you to request this particular speaker? Did you see them at an event, meet in person, etc.?

Please describe your event.

What is the name of it? Do you have a link where we can view more information on it?

What are the date(s) for this event?

Is this an in person or virtual event?

In Person

Virtual

Can be either in person or virtual

If the event is in person, where will it be taking place?

If the event is in person, will you be covering the costs of travel/lodging? What is the estimated overall cost?

Will you be providing a Speaker's Fee?

If so, please share the amount.

What role you would like Upstream to play? Check all that apply.

Facilitator

Motivation and inspiration

Provide historical perspective

Provide information

Other

Do you have an idea of the audience size for this event? If so, please give your best range of attendees and the composition of the audience.

Is there any other information you'd like to provide or any questions you have?

What is your deadline for confirming speakers?

YYYY