Contact CHATT Name* First Last Organization*Address/LocationYour email*Your Phone Number*Please describe the event for which you are requesting a CHATT speaker or speakers (i.e., the speaking topic and who is the anticipated audience):*What key messages or questions would you like speakers to address?Number of Requested Speakers (Panel or Single Speaker)Date & Time of Event (Actual Date/Time or Timeframe)Virtual or In-Person? If in-person, please describe the venue any logistics:Will this event be open to the public? If yes, please describe:Will this event allow media / recording? If yes, please describe (this will influence what speaker(s) would be comfortable participating): Δ
