Request a MI STEM Partnership Speaker

* Indicates required questions
Thank you for considering a representative from the Michigan STEM Partnership to speak at your upcoming event. Please complete the form below to help us learn about your organization, your event, and to determine your areas of interest so that we may provide the speaker most suited to present on the requested topic. Please note that speaker's may require travel-related expenses to be covered depending on the location / duration of the event and the type of group being addressed.
Name *
Company Name *
Job Title *
Work Phone # *
Mobile Phone #
Email *
What is the name of the organization / company that is requesting a speaker? *
What is the date / time of the event for which a speaker is required? *
Anticipated audience size *
Type of presentation *
Keynote Breakout Session
What is the EXACT location of the venue where your event will be held (name of venue, street address, city, state, zip)? *
Who will be attending this event (ie: educators, administrators, legislators, parents, students, business executives, etc.)? Please give as much descriptive information as possible. *
On what specific topic are you interested in having us present? *
How much time will be allocated for this presentation? *
Is your organization / firm willing to pay a speaker's honorarium if one is required? *
Yes No
Is your organization / firm willing to pay a speaker's travel fees (air travel and/or car rental, hotel, meals) if the distance and/or scheduling needs necessitate it? *
Will your organization / firm be able to provide technical support and equipment for the speaker's presentation? *
Yes No
Will you be recording this presentation by audio or video? *
Will this presentation be posted online for listening / viewing after the event? *
If this presentation will be posted online, will listeners / viewers be charged to hear / view the presentation? *
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