Speaker Request Form

If you would like to request a representative of Street GRACE to participate in you event, please fill-out and submit the form below.

Name
FirstLast
Phone Number
Email
Site of Event
Site Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Date of Event
Time of Event
: HH
MM
Event Time - start to end
Length of time given to Street GRACE Speaker (a minimum of 20 minutes is required)
Other speakers you will be inviting to the event
If the time that the speaker would need to be present at your event is different than the event time listed above, please clarify that here.
If your event is outside the metro Atlanta area, are you willing to pay travel expenses?
- Yes
- No
Expected Number of Attendees
Please explain how you are marketing your event.
Detailed Description of Event
How did you hear about Street G.R.A.C.E.?
What are you hoping your event will gain with the addition of a Street GRACE speaker?
What is the expected outcome of your event - your call to action?
Special Notes
Request Fulfillment
- I understand that this form operates only as a request. The completion and submission of this form does NOT signify that Street GRACE has agreed to participate in my event. Furthermore, I understand that any and all speaker requests are fulfilled on the basis on availability which cannot be guaranteed.