Speaker's Bureau Request FormPlease tell us about your event and your needs.Step 1 of 425%Contact DetailsName(Required) First Last Email(Required) Enter Email Confirm Email Phone(Required)Organization or congregation name (if applicable)City/Town(Required)Event DetailsEvent name (if you have one)Preferred date(s) & time(s)(Required)Event Location(Required) In-person only Online only Both in-person & livestreamedLocation DetailsPlease provide the address, if you know it.Address or platform link (if known)Please provide any details you currently know about where this will be livestreamed.Location Details (in-person & livestreamed)Please provide any details you currently know about the address of the venue plus where this will be livestreamed.Estimated number of attendees(Required)Audience & SettingWhat is the setting or format of the event?(Required)Tell us about the type of event, e.g. worship service, adult education class, public event, small group, panel, retreat, workshop, etc.Who is your intended audience?(Required)Tell us about who will be in attendance, e.g. congregation, youth group, interfaith gathering, general public, clergy, classroom, etc.Speaker PreferencesWhat topic(s) are you most interested in?(Required)Are there specific outcomes or goals you hope to achieve from this speaker’s visit?Examples: inspire action, deepen faith understanding, launch a green team, support local campaign, etc.Preferred faith tradition or background, if any.LogisticsHonorariumWe request a $150 honorarium for each speaking engagement. If the speaker travels more than 30 miles one way, mileage reimbursement is expected at the IRS rate of $0.70 per mile. I understand and agree to provide the standard honorarium and applicable mileage reimbursement. I’d like to talk more about financial support options or sliding scale availability.Technical RequestsDo you have audio/visual needs or setup requirements we should know about?How did you hear about us?Tell us more about how you learned about the Iowa Faith & Climate Network Speakers Bureau? (Search engine, email newsletter, referral, etc.)Final NotesIs there anything else you'd like us or the speaker to know?
