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Speaker Request Form
PLEASE NOTE: DISABILITY RIGHTS TEXAS REQUIRES AT LEAST 4 WEEKS NOTICE PRIOR TO YOUR EVENT TO CONSIDER YOUR REQUEST
By providing as much information as possible on this form, we can more quickly process your request and reply to you with an answer.
Contact Name
*
First
Last
Contact Daytime Phone
*
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Contact Email Address
*
Organization Name
*
Website of Your Organization
Are you requesting a speaker for a meeting or a conference? Check one
Meeting
Conference
Other reason for this request
If your speaker request is for a conference, is it for a keynote address or breakout session? Check one
Keynote Address
Breakout Session
Topic related to disability rights that you are requesting for presentation
Speaker location
(Please include Venue/Building Name, Street, Unit #, City, State, Zip)
Date & Time of Speaking Request
Target audience for speaker
*
Persons with disabilities
Families of persons with disabilities
Professionals who provide services to people with disabilities
If one of the above, please specific type of disability: (for example: autism, deaf, intellectual or developmental, special education, etc.)
Other Target Audience (Not listed above)
Estimated number of people attending presentation
*
Are you requesting that DRTx host a table or booth at a fair or conference?
Yes
No
If you are requesting that DRTx host a table/booth, please provide date(s) of fair/conference and time frames for hosting table/booth
Table / Exhibit location
(Please include Venue/Building Name, Street, Unit #, City, State, Zip)
Additional Information/Comments
Thank you for completing this form.
Our goal is to contact you with an answer within 7-10 business days once you submit your request.
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