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If you would like to book a member of The Disparities Solutions Center Faculty for a speaking engagement, please fill out the speaker request form and send us an email. The speaker request form includes the following information.

1. Contact Person


2. Organization


3. Phone Number


4. Email Address


5. Name of Event


6. Date(s) of Event


7. Location of Event


8. Brief Description of Event


9. Topic


10. Speaker Requested


11. Type of Engagement


12. Honorarium offered and amount


13. Will travel expenses be covered?


14. Type of Organization


15. Any other information you would like to share


16. How did you hear about us?