Request A Speaker

Share The Message of Hope

Our team is always eager to share our passion for empowering survivors. It would be an honor to partner with you as speakers at your event. If you would like to extend an invitation, simply complete the form below with as much detail as possible. Each request must align with Freedom a la Cart’s mission, vision and core values. Our team will review your request and reply as soon as possible.

Request Speaker

Speaker you are requesting*
Paula and a survivor are available to speak to groups of 50+ attendees. For events with less than 50 people, another staff member will be considered.
Name of Event*
Event Start Date*
MM slash DD slash YYYY
Event Start Time

: Hours

Minutes
Event End Date*
MM slash DD slash YYYY
Event End Time

: Hours

Minutes
Name of Event Location*
Event Address*
Street Address City State ZIP Code
Event Website
Event Contact
Contact Name*
First Last
Phone*
Email*
About the Event
Goal of the Event*
Please describe your anticipated audience*
Overall schedule of the event*
Anticipated number of people attending the event*
Length of time given to speak?*
Anticipated time speaker will begin*

: Hours

Minutes
Speaking Topics*
Please list any specific topics you'd like our speaker to cover.
Are you also interested in Freedom a la Cart catering services for the event?
- Yes
- No
- Maybe
Travel & Facility
Arriving Airport - if applicable
Suggested Overnight Accommodations - if applicable
Expenses covered for Speaker and Survivor
please check all that apply
- Airfare
- Car Rental
- Hotel
- Food
- Gas/Mileage
Audio Visual Access*
please describe what is available for audio visual services
Expected Honorarium?*
Comments
This field is for validation purposes and should be left unchanged.

Share The Message of Hope

Request Speaker

Event Contact

About the Event

Travel & Facility