NDSS Staff Speaking Engagement Request

Submit your information below to request an NDSS staff member for future speaking engagements.

Your Name

First

Last

NDSS Staff Member you are requesting:

First

Last

Organization/Company

Phone

Location of event or speaking engagement

Date and time of event or speaking engagement

Requested topic, subject or focus

Description of event or engagement

Estimated Audience Size

Description of who will be in the audience

Is this event or engagement in person, via phone, 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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