Webinar Speaker Request Form

Thank you for requesting to have Angela Tella as a speaker at your forthcoming webinar. To enable us learn more about the unique needs of your organisation and your audience, please answer the following questions as thoroughly as possible, where applicable.

This will ensure that your audience has a bespoke presentation that is tailored to address specific concerns and will help us contribute to the success of your event.

Your Name (required)

Your email: (required)

Your contact number: (required)

Day and date of webinar: (required)

What time do you want the Speaker to start?: (required)

Sponsoring organisation: (required)

Where did you hear about us?: (required)

 
GENERAL WEBINAR INFORMATION

A. The Webinar

1. What are the main objectives of this webinar? (required)

2. What is the theme for this webinar? (required)

3. What do you want the Speaker to speak on and for how long? (required)

4. What particular challenges for the organisation/audience should the Speaker address?

5. Are there any taboos the Speaker should avoid? YesNo

If Yes, please provide details:

6. Are there any concerns which the Speaker should be aware of? YesNo

If Yes, please provide details:

7. Will there be any media/social media coverage surrounding the webinar?
YesNo

If Yes, please include name(s) of media outlet(s) or social media platform(s):

8. Do you require the Speaker’s profile and image for your marketing activity/materials?
YesNo

 
B. The Audience

1. Expected number of attendees: (required)

2. Describe the makeup of the audience.
MaleFemaleBoth

3. Age range of audience: (required)

4. General profile of attendees (including ethnicity):

 
C. Your Organisation

1. What is the primary product or service you offer?

2. Your organisation's status:
CharityPublic OrganisationPrivate Organisation

3. Please provide a brief overview of your organisation (required)

 
LOGISTICAL INFORMATION

Please provide a named contact for the Speaker should any problems arise.

Name: (required)

Contact numbers: (required)

In compliance with The General Data Protection Regulation (GDPR), we will keep your contact details for no longer than one year following our last correspondence or until you request us to delete them. We will not distribute, sell or lease personal information to third parties unless we have your strict permission or are required by law to do so. For further details see our Privacy Policy.