Request a Speaker/ Training or Consultation

Interested in an engaging speaker or trainer for your next event? Complete this form to submit your request.

First Name

Last Name

Email Address

Phone Number

Is there any MIUSA staff you have already been in contact with regarding this event?

Event Name

Organization hosting the event

Event Street Address

Event Location

Event Date (Format: YYYY-MM-DD)

Brief description of the event

Event Estimated Attendance

Brief description of the audience

We are able to cover travel expenses of the speaker (and, when necessary, of a support person)

Advancing disability rights and leadership globally®