Event Speaker Request

Thank you for your interest in hosting a Beyond Blue Speaker at your event. To help us match the most suitable speaker to your request, please provide detailed information about your event in this form.

Please note the following requirements:

Minimum 30 days notice
Minimum of 15 attendees
Attendees are 15+ years of age
45 minutes allocated to the speaker
One session per request form

All mandatory fields are marked with *

Please select your Event Type

Please Specify

What type of speaker best meets the needs of your event?

Event Details

Event Name

On what date is your event scheduled?

We require a minimum of 30 days to process each request.

Event address

Start time of the event

End time of the event

Length of presentation required

Time selected includes speaker presentation and Q&A’s

Is the event date and time flexible?

Expected number of guests

Enter a numeric value only. Please note, we require a minimum of 15 attendees

Audience demographic

Briefly describe who is attending the event and what mental health experience you would like to hear about.

Page 2

In order to match a speaker to your request, please provide as much detail as possible about the upcoming event. Explain what you would like to gain from hearing a lived experience story, and outline what your plan is for the day.

Organisation Details

Organisation name

Street

Suburb

State / Territory

Country

Postcode

4 digit postcodes only

Please provide a brief description of your organisation

e.g. size, demographic

What is your primary motivation and key objectives for requesting a Beyond Blue Speaker?

Any other helpful information

e.g. Is there a financial component to your event? i.e. Fundraising

Page 3

Please detail below the best point of contact for the Speakers Team and Beyond Blue Speaker. This person will be responsible for the request, communicating with the speaker prior to the event and present on the day of the event.

If you are a student requesting a speaker attend your school, please ask a teacher or guardian to provide their contact information.

Organisation Contact Details

First name

Last name

Mobile number

Business number

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I understand that I need to notify the Beyond Blue Speaker Team if details change or I wish to cancel my speaker request.