Request a Speaker From Malaria No More

To request a Malaria No More speaker, please complete the form below. Please keep in mind that we are a non-profit organization: we would very much like to fulfill every request for a speaker, but we may not be able to attend due to limited resources. We will do our best to send a speaker or, if that is not possible, provide you with whatever you may need to make your event a success!

Name of Organization
First Name
Last Name
Email Address *
Phone Number
Name of Event
Event Date
Event Time
Event Address
Event Address 2
City
State
Zip
Country (If not United States)
Primary Audience *	----BusinessFaith-BasedNonprofitSchoolUniversityOther (Please describe)
If 'Other" Please Describe:
Audience Size
Type of Event *	----Conference / PresentationInformation TablePanel DiscussionOther (Please describe)
If "Other" Please Describe Event
Event Topic / Desired Speaker’s Topic *
Desired MNM Staff to Speak *	----GeneralChief Executive OfficerCommunicationsFundraisingMarketingPolicyProgramOther (Please describe)
Travel Expenses Available? *	----YesNo
Local Transportation Provided? *	----YesNo
Overnight Accomodation Provided? *	----YesNo
Do you need the speaker’s bio? *	----YesNo
Do you need the speaker’s photo? *	----YesNo
Will media attend the event? *	----YesNo
If "Yes", please descibe media
Please type the letters and numbers shown in the image.