Speakers Bureau Speaker Request Form

Contact Name:  
Contact Number:  
Contact Email:  
Date of Function/Event:  
Alternative Date of Function/Event:  
Type of Function/Event:  
Information about Company/School:  
Duration of Event:  
Duration of Speaker’s Attendance:  
Function Details Address:  
Contact Person/Facilitator:  
Speaker Met upon Arrival by:  
Where:  
When:  
Speech Topic:  
Speech Length:  
Number of Attendees:  
Issues of Interest:  
Dress Requirements:  
Do you have technical facilitation: (DVD/VHS)  
Travel Requirement:  
(Events outside the metropolitan area an Oaktree Foundation Branch may incur additional travel expenses)

Do you accept your Company/School/Organisation may reimburse/pay for any travel expenses?
Appearance Fee/Donation: Will you pay an appearance fee for a speaker’s attendance?
Will you be making a donation to the Oaktree Foundation?