Teen Pregnancy Prevention: Contact Us - Resource Bureau Request Form

Speakers Bureau Request Form

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The National Campaign to Prevent Teen Pregnancy has created the Speakers Bureau, to enable us to respond to requests for Campaign staff to speak at conferences, workshops and meetings. If you seek a speaker, please complete the following form. We will respond to your request as soon as possible. You may submit this request form on the web, by fax, or by mail to:

National Campaign to Prevent Teen Pregnancy
Speakers Bureau
1776 Massachusetts Ave., NW, Suite 200
Washington, DC 20036
Phone: 202-478-8500
Fax: 202-478-8588 Attn: Resource Bureau
www.teenpregnancy.org


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first name	*			ext.
middle		fax		( ) -
last name	*	email	*
suffix

degree		org 1
title		org 2

address 1	*	address 2		(eg. suite, apt. #)
city	*			(eg. suite, apt. #)
state	**
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country	*

Speakers Bureau Request

name of event	*
event location	*
event dates
host/sponsor(s)
contact person
fax
phone
email
Characteristics of Audience
Number of attendees expected
Are you a member of a teen pregnancy prevention coalition?

Will you pay for travel and lodging expenses for the presenter(s)? Please describe your policy on travel, expenses and reimbursement.


We request that a modest honorarium be paid directly to the Campaign to partially offset the cost of our participation. We request an honorarium of $1,000 when Sarah Brown, the Campaign Director, speaks, and up to $750 (the amount is negotiable) when another member of the staff presents. Honoraria for staff (other than the Campaign Director) will be determined based on your specific request and situation.
		Yes we are able to pay Unfortunately, we are unable to pay, but still request your participation

Do you plan to have any media coverage of this event? If yes, please specify.
Will teenage parents be participating in this event? If so, in what capacity?
Attire
Please provide additional details you think would be helpful in our review of your request.

Focus of Speech/Remarks:
check up to three

Overview of Teen Pregnancy, including discussion of data and trends,

Putting What Works to Work: Effective Programs Working with the Press/Media

Engaging Parents in Preventing Teen Pregnancy Involving Youth in Preventing Teen Pregnancy

Progress Pending: How to Sustain and Extend Recent Reductions in Teen Pregnancy Rates National Day to Prevent Teen Pregnancy

14 and Younger: The Sexual Behavior of Young Adolescents Current Culture Wars: Reducing Conflict in Teen Pregnancy Prevention

Not Just Another Single Issue: Thinking About Teen Pregnancy More Broadly Federal Policy Update

other:

Description of Needs:

If you have questions, please call 202-478-8500.