Speaker Request Form

First Name

Last Name

Email

The Matriots envision a world where all women have equality, influence, and power. We exist to advance women's equal participation in all aspects of political life in Ohio. As Matriots, we believe in and fight for these values: Equality, equity, health, safety, and independence for all women. Dominion over our bodies and access to affordable health care services. Healthy, safe, and secure communities for us, and our families. Economic independence including equal access to education, and workplaces safe from discrimination and sexual harassment. Political empowerment of women resulting in gender parity in a representative government.

By completing this form, the requesting organization fully believes in and supports The Matriots values stated above.

Requesting Organization Name

Event Desciption

What is the purpose/objective/goal of your event?

Event Date

Event Time

Event Location

Requested Presentation Topic

Link to Event's Registration/Website

Will there be a resource table for The Matriots to provide collateral materials?

Yes
No

Will media be invited to this event?

Yes
No

Will this event be reported on or broadcasted?

Yes
No

Will the presentation be recorded?

Yes
No

Will the event be photographed or videotaped?

Yes
No

If the event will be photographed or videotaped, will The Matriots have access to footage and photos?

Yes
No

Will we have access to your attendee list? If not, may be bring our own sign-in sheet?

Speaker Details & Preferences

Event Speaker, if preference. https://matriotseducationfund.org/meet-the-team/

What time would you like the speaker to arrive?

What time will the speaker begin?

What time will the speaker finish?

Will a speaker honorarium be provided? If yes, please indicate the amount.

Will there be reimbursement for travel-related expenses? Pleae check all that apply.

Mileage (at federal rate .70 per mile)
Lodging
Meals
None

Will you require any of the following (Please choose all that apply):

Speaker Bio
Speaker Headshot
Speaker Introduction
N/A
Other

Type of presentation. Please choose all that apply.

Activism Fair/Tabling
Panel Discussion
Lecture Style
Other

If panel discussion, who are the other panelists? If you chose "other" above, please explain.

Will the presentation be followed by a moderated Q & A?

Yes
No

Description of audience (please be as specific as possible. Example: Students, Elected Officials, Business Leaders, etc.)

Estimated audience size:

Please submit your draft agenda and/or other supporting documents by clicking the link below:

Upload Documents Here

Please include any other details you would like to share here.

Timeout Warning

Speaker Request Form

By completing this form, the requesting organization fully believes in and supports The Matriots values stated above.

Speaker Details & Preferences

Please submit your draft agenda and/or other supporting documents by clicking the link below: