The Ruckus Society : Speaking Request Intake Form

Speaking Request Intake Form

Thank you for your interest in bringing a representative from The Ruckus Society to speak for your group/event.

Please take a moment to fill out the form below, and then we will follow up with you as soon as possible. Your responses do not need to be long, as long as they answer the questions.

If you have any questions, please email ruckus@ruckus.org

(This form can be found at http://www.ruckus.org/speakingrequest)

Contact Information

* Organization Name

Web Page

* First Name

* Last Name

* Email

* Phone

* Street

* City

* State

* Zip

Speaking Logistics

* Date(s) and time of event (at least one month away)

* How much time is allotted for the speaker?

* Location of event

Any other logistics information that you want to share:

Background Questions

* Why do you want Ruckus to speak at your event? (Please identify if you are requesting a specific person, such as Adrienne Maree Brown).

* What topics would you like the speaker to cover?

* Is the speech part of a larger conference or event? Will there be other speakers?

If yes, please explain a little about the event, and how you see this speaker fitting into the overall event.

* Who will the audience be? How many people do you expect to attend? (group make-up, constituency, culture etc.)

* Is your group/the audience familiar with non-violent direct action? Please describe.

Finances

We expect that the speaker’s travel, lodging, and food be covered, in addition to a speaker's honorarium.

* How much of an honorarium would your group be able to contribute (in addition to travel, food, and lodging)?

Other Information

How did you find out about the Ruckus Society?

Anything else we should know?

note: due to the large number of requests we receive, we, unfortunately, are not able to fulfill each request.

First Name

* Required Field