Request a Speaker

Would you like a member of the Cover Georgia coalition to speak to your organization, or at your event? Fill out the form below and we’ll get back to you as soon as possible. Please note that we require at least two weeks’ notice for most speaking events.

Contact Information

First Name

Last Name

Phone Number

Position at Organization

Name of Organization

Organization Location (Address, City, State)

Event Information

Name of Event

Date of Event

Time of Event

Event Location (Address, City, State)

Theme or topic of the event

Proposed topic or area of expertise for the speaker

Event format

Expected audience size

Does your organization provide an honorarium, or pay for costs associated with speaking engagements (i.e., lodging, mileage or, meals)?

Additional information about the event