Speaker request form

Speaker request form
Thank you for contacting the NICE events team.

The information provided below will be used to contact you about your enquiry.

Completing this form
- Please only make requests for a NICE speaker via this form.
- Please give us as much notice and information as possible in order for us to deal with your request as effectively as possible.
Data Protection

For more information about how your data will be processed please see our Privacy Notice.
Name*

First NameLast Name
Position*
Company name*
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number

Event title*
Date and time of event*
What format is your event?*

VirtualIn personHybrid
Where is the event being held?
Do you require a speaker to attend the event in person or virtually?*

In personVirtuallyEither

Is your conference a...?*

ConferenceRound table discussionClosed meetingDifferent type of event
Please specify
Is there a link to the event online?*

YesNo
Please provide link

Who will be attending your event?
Estimated number of attendees*
Is your event sponsored? Please note: We are generally unable to provide speakers for events that are hosted or sponsored by a single industry as this could constitute a conflict of interest. Please contact speakers@nice.org.uk for more information.*

YesNo
If yes, please provide details
Which sectors do you expect your audience to be from?*

Details of your request for a NICE speaker
What topic would you like the NICE speaker to cover? *
Please provide as much detail as possible in order to help us identify the most appropriate potential speaker for your event.
Do you have a particular speaker in mind?*

YesNo
Please state
Does your request relate to a specific piece of NICE guidance?*

YesNo
Please specify
How long will you require the speaker to be at the event?*
Should be Empty: