Request NDSS Staff for your Buddy Walk

Submit your information below to request an NDSS staff member to attend/speak at your Buddy Walk.

Your Name

First

Last

NDSS Staff Member you are requesting:

First

Last

Organization/Company

Phone

Location of Buddy Walk

Date and time of Buddy Walk

If requesting a speaker, provide requested topic, subject or focus

Estimated Audience Size

Description of who will be in the audience

Are you requesting attendance in person or via video conferencing

If this engagement requires travel please specify the anticipated travel itinerary.

Are you able to cover travel costs for staff requested including airfare, lodging, and meals? Please note that our self-advocate staff members require one additional staff member to accompany their travel.

Yes

Are you able to cover speaker honorarium?

Yes

If you checked yes, please provide your intended honorarium range in dollars.

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