Speaker Request Form Name of Event Date / Time Location Subject/Theme of Event Name of Person Making Request What Institution/Agency/Group are you affiliated with? Phone Email Website/URL Which of the following service(s) are you requesting? Conference Keynote Speech/Lecture Commencement/Graduation Address Commissioned Article/Report Workshop/Training Webinar/Teleconference Climate Study/Assessment Research Study Grant Writing Panel Invitation OtherIs your event in-person or virtual? If a conference is it regional, national, or international? If other, please describe Event description Is this event firm, tentative, or other? Firm Tentative OtherIf this event requires travel, will TRAVEL COST be paid by your institution/agency? Yes No PossiblyIf this event requires overnight stay, will LODGING COST be paid by your institution/agency? Yes No PossiblyAre there budget constraints that we might consider with your request? Speaker fees/honoraria vary based on a number of factors (e.g. prep time, duration, # of talks) however, we strive to offer affordable, competitive rates that make it possibe for us to work with a diverse group of stakeholders and institutions. What is the nearest airport to your event/venue? (We will use this airport code to estimate travel expenses) Who will make up your audience/target audience to attend? What is the size of the audience? Less than 50 50 - 100 100 - 300 300 - 500 500 - 1000 1000+What perspective would Dr. Fred Bonner II add to your event? Are there topics or areas of particular subject matter you're interested in hearing about from him? Will media be in attendance? Yes NoPlease list other confirmed participants in your event we might want to know about: Is there anything else you would like to share with us that will help us with our consideration? Submit