Keynote/Speaking Engagement Questionnaire

Please fill out this form completely. We will contact you via email after submission.

Name

Phone number

Event contact person

Contact person email

Name of organization

Event name

Date(s) of event:

Is this event virtual?

Yes

If virtual, do you want to be able to record and share the recording?

Yes

If in person, location of event: (address, city, state, zip)

Hours of event

Number of participants expected

Audience description: (please describe or check all that apply)

Early childhood classroom teachers

Elementary classroom teachers

Middle school classroom teachers

High school classroom teachers

Non-classroom educators (non-profits & organizations included here)

What theme, if any, are you focusing on?

Tell us a bit about your organization. What should we know?

How did you hear about us? Why do you think we are the ideal facilitators for this professional development?

Please select the budget range for your work. We encourage you to take time to be clear about funding as you submit this inquiry.

As we get excited about possibly partnering with you, what are you most looking forward to about this work?

Form submission[]

In the case of an in-person event: Due to the nature of what Multicultural Classroom® facilitators discuss, teach about, and publish in this current political and social context, security and protection are necessary. We invite you to take our safety into consideration as you plan for this event.

Keynote/Speaking Engagement Questionnaire

Contact us and tell us a little more about what you are looking for.