Speaker request

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Welcome to Eureka Mums! If you would like a representative of our organisation to speak at your event please enter the details below.

Date: *
Location: *
Host Organisation: *
If your organisation wishes to fundraise on our behalf please ensure that you have completed a Permission to Fundraise form. If you are planning to collect a financial donation on the day or if you have a speaker's fee budget for the event could you provide us with an estimate? * $
Our Operations Manager Trinsa Lewis donates 100% of her speaker's fee to Eureka Mums. If Trinsa is not available we have a number of talented speakers who all volunteer their time. If you are not in a position to fundraise at your event, please consider hosting a collection of material aid to assist us in continuing our vital work.
What time does the speaking engagement start:
Number of Attendees:
Your First Name: *
Your Last Name: *
Your Phone Number:*
Your Email: *
Notes (if any)

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