NSC Speaker Request Form | National Safety Council

NSC Speaker Request Form

Would you like to request an NSC Speaker for your next event?

Here is a list of NSC Experts.

Complete the form to share information about your speaker needs and upcoming event. Please submit requests at least one month before your event date. This advance notice allows time to evaluate your request and coordinate with our speakers.

For questions about the NSC Speaker Request process, please contact media@nsc.org.

Contact Information:

First Name*

Last Name*

Phone Number*

Email*

Host Organization Details:

Host Organization Name*

Is your organization a National Safety Council member?*

Do you have a contact at NSC?*

NSC Contact Name:

Event Details:

Is your event being held in-person?*

If YES (In-Person):

Event Location

Event City

Event State

Event Country

Event Name*

Event Date*

Event Start Time

Event Time Zone*

Presentation Type*

Presentation Topic*

What is the total presentation length including questions and answers?*

Number of Attendees*

Audience Description*

Event Description*

Event URL

Confirmation Date Requested By*

Do you have a preferred speaker in mind?*

Is compensation available for travel expenses?*

Is compensation available for a speaker honorarium?*

Is this event or any part of the event a fundraiser?*

Terms and conditions: I agree that no person for reason of race, color, sex, religion or national origin, will be excluded from or segregated within membership in sponsoring organization, attendance at event or any of the facilities housing this event. I also agree to receive communications from NSC about the Speakers Bureau.*

For questions about the NSC Speaker Request process, please contact media@nsc.org.

NSC Speaker Request Form

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