Speaker Request Form - BRACE Alzheimer's Research

Speaker Request

Thank you for your support of dementia research. Please be aware that BRACE Dementia Research is a small charity based in Bristol, England.

We are only able to provide in person speakers to groups that are close to the Bristol area. For groups further afield, we can offer online speakers. Thank you for your support.

Speaker Request Form (community groups)

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Name of Organisation(Required)

Purpose of Organisation(Required)

Name of person making the booking(Required)

First Last

Your Email Address(Required)

Email Address Confirm Email Address

Your phone number(Required)

Organisation address/address where the talk will take place(Required)

Street Address Address Line 2 City ZIP / Postal Code

Please note we can only provide in person speakers for addresses that are in or close to Bristol, in England, due to being a small charity.

Name of person chairing the meeting (if applicable)(Required)

Date and time of meeting(Required)

Alternative Dates (if possible)

Time Speaker should arrive(Required)

Approximate time allotted for Speaker(Required)

Time meeting should finish(Required)

Approximate numbers expected

Does the venue provide IT facilities or if online Zoom or another video conferencing option? If so, what is provided?(Required)

Is parking provided(Required)

At the venue

On street

N/A

Would you like the speaker to bring a selection of BRACE fundraising sales items?(Required)

Yes

N/A

Any additional information you feel is relevant regarding the talk/meeting?