Book A Survivor Advocate

If you would like to request to have a safe steps Survivor Advocate speak at your organisation or community event, please fill out the Book a Speaker form below. Please note, we cannot guarantee a Survivor Advocate will be available to appear at your event.

Fields marked with an asterisk * are compulsory. Your form will not be submitted if these fields are not filled in.

Organisation Organising Event:*
Name of Main Contact:*
First Last
Contact Number:*
Contact Email:*
Tell Us About Your Event
Date of Event:
Month
Day
Year
Address of Event:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Time of Event:

: Hours

Minutes

AM/PM
Time of Presentation:

: Hours

Minutes

AM/PM
Requested Arrival Time:

: Hours

Minutes

AM/PM
Requested Departure Time:

: Hours

Minutes

AM/PM
Meeting Person and Contact Number
Meeting Location:
Duration of Presentation:
Do you want speaker to answer questions - if so how long for:
Number of Attendees:
Demographic of Attendees:
The advocates will share their story but would you like any other topics covered:
Parking Options
What date do you need this speaking request confirmed:
Month
Day
Year
Is PowerPoint presentation available?
- Yes
- No
Would you like the speaker to bring some safe steps resources:
- Client Services English Brochures
- Client Services Multi Language Brochures
- safe steps Posters
- safe steps 1800 Number Business Cards
Other comments:

Tell Us About Your Event

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