CBWG Speaker Request Form

Please fill this form to request the presence of the Commission on Black Women and Girls at your event.

Please ensure this form is submitted at least 4 weeks in advance of the event. Subject to the availability of the Commission members.

Requestor information

Title

First

Middle

Last

Suffix

Email Address

Event Information

Organization Name

When does the event take place?

Is this event virtual or in-person?

Address

City/Town

ZIP/Postal Code

What is the name of the event?

Provide a brief overview of the event.

Are you requesting the presence of the body of the Commission or a specific member?

Please list the member(s) of the Commission you are requesting for.

What is your specific ask of the Commission member(s)? Please specify what exactly you would like them to speak on and the overall goal you would like to achieve by having the Commission member(s) present.

How many people do you anticipate attending the event?

Upload any flyers, briefs, or information pertinent to the attendance of the Commission member(s).

One file only.
255 MB limit.
Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx avi mov mp3 mp4 ogg wav.

CBWG Speaker Request Form

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Requestor information

Event Information

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