Speaker Request Form

Thank you for requesting Arlene Boehnlein-Rice, Founder of The Gabriel Project 930, as a speaker for your group. In order that we might have as much information as possible, please help us by filling out the questions that follow. We will get back to you as soon as possible.

Arlene speaks on the following topics listed below. If there is another subject you would like to request, mention the topic in the speaker request form. Contact us for any questions you my have about speaking information.

Persevering Faith: When You Lose a Child to Addiction
Breaking the Silence of Addiction
How Do I Know if My Child is Addicted to Drugs?
How Do I Get Help for My Child? What if My Child Refuses Help?
Shedding the Enabler Label
Naloxone Overdose Rescue Training- Provided by the KY Harm Reduction Coalition (KYHRC).

What is the purpose of your event?

What is the subject you would like covered?

Are you expecting handouts, Powerpoint, or other related items?

Who is the audience, and what do you see as their biggest need (s)?

How many do you expect to be in attendance?

Who is the contact for the Event?

Your Name:

Address

City

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Zip / Post Code

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When is your event (date and schedule)?

When will the speaker begin and end the message? What is the timeframe for speaking?

Where will your event be held (please include address and phone)?

Venue Name: Phone: # Address:

Where will the speaker stay (please include hotel name, address and phone)?

Hotel Name: Address: Phone:

What will be the dress for the event?

FormalCasualSemi-Casual

How will travel be handled (arrangements, etc.)?

How will payment be handled (honorarium, expenses)?

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