I CAN Network Speaker Services – Expression of Interest

I CAN Network Speaker Services - Expression of Interest

Thank you for your interest in the I CAN Network. Please complete the form below and we will contact you to discuss our speaker services.

* Please note that this form is not for schools. If you are enquiring on behalf of a school please click here.

Organisation Details

Organisation Name

Organisation Address

State

Postcode

ABN (11 digits)

This is required for us to issue a Speaker Service Agreement.

Your Details

First Name

Last Name

Position

Phone

All speaking engagements require the organisation to agree to terms and conditions which are contained in our service agreement.

Please tick this box if you are authorised to sign such an agreement

Authorised Signatory Details

First Name

Last Name

Position

Phone

Event Details

Which I CAN speaker service/s are you interested in or would like further information on?

Please provide further details:

If you would like to request a specific speaker please enter their name here:

Do you require a speaker to present online or face-to-face?

Do you know the date of your event/date speaker required?

Please enter the date:

DD/MM/YYYY

Is the event being held at the organisation address listed above?

Please enter the address of where the event is being held?

How did you hear about I CAN Network?

Thank you for your expression of interest!

I CAN Network Speaker Services - Expression of Interest

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