Speaker 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?

The Speakers Team requires a minimum of 30 days to process each Speaker Request to identify an appropriate and available Speaker.

Event Address

Start Time of the Event

End Time of the Event

Is the event date and time flexible?

Expected number of guests

Please enter a numeric value only

Audience demographic

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

Length of presentation required

Time selected includes Speaker presentation and Q&A’s

Organisation Contact Details

First name

Last name

Position at Organisation

Mobile Number

Business Number

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

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

Consent

I have read and accept the Beyond Blue Terms of Use and Privacy Policy *

I would like to be kept up-to-date with Beyond Blue news through email communications.