ADL Speakers Bureau Speaker Request Form First and Last Name:*Title:*Organization:*Event Address:*Phone 1:*Phone 2 - CellE-Mail:*Speaker Presentation Topic:*AntisemitismExtremismIsraelCivil RightsSuggest Another Topic:Preferred Program Date(s):*Program Start - End Time:*Expected Audience #:*Audience Age RangeBrief Description of Audience (age range, etc.)*Is your event in person or virtual?* In Person Virtual Flexible If your event is in-person are you able to provide A/V Equipment? Laptop Screen Projector Speakers Microphone If your event is in-person are you able to provide A/V Equipment? Laptop Screen Projector Speakers Microphone The requested honorarium for ADL speakers is $1,000 for in person events and $500 for virtual events. Please indicate if your organization is able to accommodate this* Yes No ADL provides expert speakers for a range of programmatic opportunities and respectfully requests a contribution equal to the size and scope of your event. Are you open to having a conversation about establishing a partnership?* Yes No Are you considering publicizing this event in local media? If yes, please work with our office to approve any copy before releasing it to the public.* Yes No Questions or Comments:
