Request a speaker

Thank you for taking the time to complete this form to request a speaker. We just need a few details from you and we will be in touch very soon. It shouldn’t take you more than 5 minutes to fill out this form.

YOU NEED TO BE OVER 18 YEARS OF AGE TO COMPLETE THIS FORM. If you are a student please make sure a teacher fills in this form.

Contact Details

Title:

First name: (required)

Last name: (required)

Email:

Contact number: (required)

Preferred method of contact:

Your role at organisation / school:

Organisation / School name:

Address line 1:

Address line 2:

Address line 3:

Address line 4:

Postcode:

Preferred date of talk:

Start time of talk in 24-hour format:

Are you flexible around the date and time?

Length of talk required (myaware talk is usually approx. 30 minutes)

Number of attendees:

Are we able to offer a ’virtual’ presentation for you?

Do you have the relevant internet connection and equipment available for this to be possible? Please outline what equipment you have available:

If we give a talk in person, do you have the relevant equipment available eg: projector / screen / microphone?

How did you hear about myaware?

Additional information, is there anything else we need to know?

Myaware is committed to protecting your personal information, being transparent about what we hold and ensuring that we use it in accordance with applicable laws concerning data protection. To see how we use your personal information please read our privacy policy at www.myaware.org/privacy-policy. If you would like a printed copy email [email protected] or call 01332 290219. Myaware is a registered charity in England, Wales and Scotland. All myaware Community Speakers are DBS checked.

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