Living In Liberty


Speaker Request Form
Fill out our Speaker Request Form and a member of our Awareness & Prevention team will be in touch!
Date of Request *
Contact Information
Enter the primary contact information.
First Name *
Last Name *
Email *
Contact Phone *
Event Request Details
Enter the location of presentation (please include exact address for finding location on Google maps):
Date of Presentation *
Time of Presentation *
Length of Presentation
Event Location Name *
Address 1 *
Address 2
City *
State/Province *
Zip *
Presentation Details
Please give us more details about your speaker request.
Type of Presentation (select one): *
Estimated number of people in audience.
Description of target audience.
Topic Interest (What does the audience want or need to hear about related to human trafficking?):
Does the facility have equipment and screen for Powerpoint presentation and to project video with sound?
If equipment is available, how do you prefer to receive the Powerpoint file?
If no equipment is available, may we bring our own to set up?
Additional information and notes:

Timeout Warning