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Community Speaker & Event Request Form
Community Speaker and Events Request Form
Contact Information
Name
*
Name
First Name
First Name
Last Name
Last Name
Email
*
Phone
*
Ogranizational Information
Name of your organization (if applicable)
Address of the organization
Type of Organization
*
School
Nonprofit
Business
Government
Other
Other
Event Information
Date of Event
*
Start Time
*
12
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:
00
30
AM
PM
End Time
*
12
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7
8
9
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:
00
30
AM
PM
Is this event a:
*
Specialized presentation (training or expert discussion, tailored to your specific groups needs/goals)
General presentation (information about Maltby and our services)
Vendor Booth (opportunity for the community to walk by and learn about our services)
Other
Other
Preferred format
*
In-Person
Virtual
Hybrid
Age range and/or demographic of attendees
*
Expected Audience Size
*
Specific objectives or goals for the presentation
*
Logistics & Venue
Venue/Location (if in-person) or virtual platform details (if applicable)
*
Will any technology/supplies (e.g., projector, microphones, extension cords, table, chairs) be available? If yes, what is provided?
*
Will there be any special accommodations or accessibility requirements?
*
Additional Information
Are there any particular speakers or team members you’d prefer for the presentation?
Is this event for English or French speakers?
*
English
French
Bilingual
What is your budget for this presentation/speaker event? (please include honoraria/grant monies or $0 if there is no budget)
*
Any additional requests or special considerations?
How did you hear about our agency or community presentations?
*
Have you booked a community Speaker/Event with us before?
*
Agree
*
* By submitting this form I consent to being contacted by Maltby Centre. This information will only be used to make initial contact and will not be distributed to third parties nor entered into any provincial records.
Submit
If you are human, leave this field blank.
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