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BOOK A TALK ON HEARING DOGS HERE
!! FORM HAS NOT YET BEEN ACTIVATED !!
FOR ENQUIRIES PLEASE CALL TOLL FREE
0800 - funding | 0800 - 386 346


Full Name of Your Organisation, School, Club or Group:  
Your Organisation’s Postal Address:  
 

PRIMARY CONTACT PERSON FOR THIS EVENT:
Full Name:
Email Address:
Telephone Number: (landline)
Telephone Number: (mobile)

SPEAKING ENGAGEMENT DETAILS:
Meeting Date: 1st preference
                       2nd preference
Usual meeting start time:
Usual meeting finish time:

Speaker's start time:

Expected Duration of Talk:

Venue Address:
Is on-site carparking available?   
Is a laptop with Powerpoint available for use on site?    Yes No
Is there a screen or blank wall area to project onto?    Yes No 
Is a data projector provided on site?    Yes No

Please note that if a laptop, screen and data-projector is not provided, our speaker will bring this equipment and require access to the venue at least 30 minutes before the meeting start time.

Approximately how many people do you expect will attend this event?

Donations to Hearing Dogs for Deaf People are invited in lieu of a speaker’s fee and can be relayed via the speaker or sent directly to Hearing Dogs for Deaf People.    For events outside Rotorua, accommodation if required and travel costs need to be covered by the host organisation.  Please calculate mileage at 62c/km rounded to the nearest $10 and note the amount you expect to contribute towards travel costs here (groups outside Rotorua only):
 
Any other Comments or Special Requests:


 

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