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
Family Education Weekend & Crawfish Boil
Summer Leadership Weekend
HOPE Gala
Prophy Conference
Qualified Training
HOPE Conference
Contact
Request A Speaker
In Crisis?
Blog
Donate