FoMSF Speaker Request FormPlease answer the following questions so that we can assess your event needs and let you know whether we are able to organise an appropriate speaker from our pool of field volunteers who have recently returned from missions in over 70 countries worldwide.

1. You name

2. Which group are you from

3. Your contact details

4. What is the purpose of the talk? (e.g. information, volunteering or fundraising)

5. Do you have a particular field of specialisation which you would like covered? (e.g. medical, project co-ordination, nutrition, general MSF chat)

6. Event details (Date, time and duration)

7. Venue address (be specific about room numbers if appropriate)

8. Will you be requesting supporting material? If so, please give details

9. To which address should support material be sent to prior to the event

10. What is the anticipated size of the audience?

11. Are you planning on advertising this event? If so, how?

12. Can the Talk be open to other interested guests?

13. What technical facilities can you provide? (e.g. video, projector)

14. Will you be able to cover the travel costs for the speaker?

15. Please give any other details you feel of relevance

Please send completed forms to: Aisha Dodwell, Public Engagement Manager, aisha . dodwell @ london . msf . org