Request a Speaker

Know someone who would make a great speaker, or have a topic you'd like the club to explore? Fill out the form below — the speaker organizer will follow up with you.

Fields marked * are required.

Your Information

Name *

Phone (optional)

Email *

About the Speaker

Speaker Name *

Speaker City / Location

Speaker Email (optional)

Speaker Phone (optional)

Topic *

Speaker Role

Opening Speaker (5–10 min) Main Speaker (~20 min) Either Unsure

Speaker Photo (optional — JPEG or PNG, max 4 MB)

Image is too large — please choose a file under 4 MB.

Brief Bio (who are they and why would members enjoy this?)

Scheduling

Approximate Date Recommendations (optional)

Preferred Meeting Time

Morning Evening Either Unsure

Speaker Availability / Format

Available mornings Available evenings Zoom only (not in person)

Coordination

Have you already spoken with…

The speaker organizer The president

Anything Else?

I have other suggestions (see comments)

Comments (optional)

Leave this blank

✓ Request submitted!

The speaker organizer will be in touch. Thank you for helping build our program!