Speakers Bureau Booking Form

Primary Contact*

First Last

Please provide the name of the primary contact we should connect with.

Organisation Type*

Current Threads of Life funding partner

Corporate Client

Educational Institution

Nonprofit or government agency

Other

If “other”, please include organisation name.

Organization/Company Name*

School Name*

Primary Contact's Address*

Street Address Address Line 2 City Province Postal Code

Email*

Phone*

Event Name*

This presentation will be*

Virtual

In-person

Hybrid

Platform for virtual presentation*

Zoom? Google Meets? Teams?

What is the allotted time being considered for this presentation?*

5 minutes? 30-45 minutes? To be determined? What is the ideal time you’d like the speech to be?

# of presentations requested*

Single

Multiple

Are you looking for a single presentation, or multiple presentations?

Presentation Date*

Speaker Start Time*

First Presentation Date*

First Speaker Start Time*

Second Presentation Date

Second Speaker Start Time

Third Presentation Date

Third Speaker Start Time

Fourth Presentation Date

Fourth Speaker Start Time

More than 4? Wow.

Please provide additional details here.

Day of event contact*

Primary contact

Other

Cell phone # for day of event contact*

Email for day of event contact*

Is there a theme or topic for this event?*

How many people are expected to attend?*

And what are their professional roles?*

This information helps our speakers better understand their audience.

What trades or areas of study are the students engaged in?*

This information helps our speakers better understand their audience.

How did you learn about our Speakers Bureau?

Heard another speaker

Trade Show

Event

Other

Financial Contribution to Threads of Life*

Threads of Life is a registered Canadian charity. Our speakers are volunteers who donate their time and very personal story in the hope of preventing future workplace tragedies. They do so with the expectation that a contribution will be made to Threads of Life. For example, a contribution of $1800 allows one person to attend a family forum. A contribution of $1200 sends an issue of our print newsletter to 500 families. How much will you pledge as a financial contribution in response to a Threads of Life speaker’s presentation?

Financial Contribution to Threads of Life – Formal Funding Partners

If there is a formal funding partnership between your organisation and Threads of Life, your presentation may be fully funded. However, if you would also like to voluntarily add a financial contribution amount and/or cover speaker travel expenses to get to your event, please indicate below.

Financial Contribution to Threads of Life – Educational Institutions

Threads of Life is a registered Canadian charity. Due to the generosity of our current partners and donors, Threads of Life is pleased to provide speakers for educational institutions such as trade schools, universities, community colleges, and high schools free of charge. Some restrictions may apply and there is a black out period for educational events from April 1 to May 15. However, if you are able to provide a financial contribution and/or contribute to speaker travel expenses please indicate below:

Financial Contribution to Threads of Life – Nonprofit or government agency

Threads of Life is a registered Canadian charity. We know that budgets vary for nonprofits across the country. Please be aware that the Speakers Bureau program relies upon financial contributions to train and support our speakers as well as our support programs for individuals and families who have experienced a workplace tragedy. We ask that you agree to cover travel expenses for our speaker(s) and to make a fair financial contribution corresponding to your financial ability. If you’d like to discuss, please indicate below.

Volunteer Expenses*

Travel expenses, food and lodging (where applicable) will be covered by the organization booking a speaker. A few of our volunteers require compensation for lost wages as they must take time off work to speak at an event. An estimate of expenses will be provided during the booking process.

I understand the expense agreement outlined above.

Please note that Threads of Life speaker presentations and materials are the property of our volunteer speakers. Recording is not permitted unless discussed with Threads of Life in advance. Copying and distribution of presentations, powerpoint files or photos is prohibited.

Speakers Bureau Booking Form

Book a speaker for your event