Hope For Hemophilia
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Request a speaker for an event
EVENT CONTACT
*
Indicates required field
Name
*
First
Last
Phone Number
*
Email
*
Name of Event/Organization
*
Website
*
Event Address
*
Line 1
Line 2
City
State
Zip Code
Country
EVENT SPECIFIC INFORMATION
Date
*
Time
*
Expected Attendance Size
*
Time Commitment
*
Under 30 minutes
30 minutes to 45 minutes
45 minutes to 1 hour
Over 1 hour
Request Type
*
Presentation
Informational Booth
Panel
Other
Audience Profile
*
Elementary Students
Middle School Students
High School Students
Collegiate
Business/Company
Nonprofit
Faith Community/Church
Other
Speaking Topic
*
Event Focus
*
TRAVEL EXPENSES PROVIDED
please select which applies
*
Hotel
Air / Train Travel
Honorarium / Guest Offering
None
Honorarium / Speaking Fee Amount
*
Speaker Attire
*
Event Attire
*
AUDIO VISUAL COMPONENT
Name of A/V Contact Person at your facility
*
First
Last
A/V Equipment Available
*
Projector / Screen
Speakers
Ability to play PowerPoint and DVD
Audio: Headset Mic
Audio: Lapel Mic
Audio: Handheld Mic
Do you need the speaker's photo?
*
Yes
No
Will press be present?
*
Yes
No
May we display our product at your event?
*
Yes
No
Any other needs or information?
*
Submit
Home
About
What We Do
>
Programs
Patient Stories
Meet Our Team
>
Board of Directors
Our Amazing Staff
James' Family Story
Resources
Leader Resources
Products
Sponsors
Financials
Events
Joint Health Event
HOPE Groups
HOPE Crawfish Boil
SPRING LEADERSHIP WEEKEND
HOPE Gala
SUPERHERO HOPE 5K RUN/WALK
HOPE Conference
Calendar
Contact
Request A Speaker
In Crisis?
Blog
Donate