MIRC Presentation Request Form
Please use this form to request a presentation from MIRC. 
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Email *
Name of Organization Requesting Presentation *
Name of primary Contact Person for this request *
Phone Number of Contact Person for this request *
Day & Time of Presentation (if known)
Length of Presentation *
What is the anticipated audience size? Best estimates are fine. *
What is the event format? *
What region are you located in? *
Would you consider a virtual (e.g. Zoom) appearance if the staff member available to present is not based close to your location? *
Would you consider a web-based pre-recorded presentation if that matches best with your request? *
Which language(s) would you like the presentation in? Please select all that apply. *
Required
Will this event be for invited guests only or open to the public? *
Presentation Topic *
Required
Does your group or audience: (check all that apply) *
Required
Do you already have a main contact person at MIRC? If so, who?
We do not charge for our presentations and trainings, but we do always appreciate an honorarium to support our work. Are you a well-resourced organization interested in providing your speaker with an honorarium?
Clear selection
Would you like to be added to our newsletter email list to stay up to date with MIRC?
Clear selection
Is there anything else that would be helpful for us to know in order to respond to your request?
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