A NSW Government website


Speaker Request Form

Contact Details
Enter your full name
Event Details
Enter the name of your event and what it’s about
Enter the date of your event
Enter the location of your event
Enter the name of your requested speaker
Size and description of audience
Enter the type of format, purpose (e.g. speech, presentation, panel, Q&A etc.) and the approximate duration
Who will moderate or MC the session
Enter the theme for discussion.
Is the event open to media? *
Will the event be recorded? *
Which other speakers have been confirmed
Please enter any further details including origins of the event, links to campaign websites or flyers and context to help us assess the invitation. As well as any key messages you would like the speaker to get across.