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NEALE DANIHER AO APPEARANCE REQUEST FORM
1.
Organisation name?
2.
Organisation Contact Name? (Name, Email and Phone number)
3.
What kind of event is this for?
Fundraiser/Charity
Corporate
Professional
Awareness
School Visit
Other (please specify)
4.
The purpose of the proposed event?
Motivational
Informative
Leadership
Staff Engagement
Health & Wellness
Other (please specify)
5.
What will the Alumni’s role be at the event?
Keynote Speaker
Panel Member
Q&A session
Fireside Chats (format between MC & Speaker)
Other (please specify)
6.
Due to Neale’s medical condition, it may be difficult for him to attend all events in person. As such, is virtual attendance (video message, Skype/Teams) possible?
Yes
No
7.
Is a representative acceptable if the Alumni is not able to attend in person, such as Bec or Jan Daniher?
Yes
No
8.
How big is the audience?
Less than 20
21-50
50-100
Over 200
Other (please specify)
9.
Will you cover flights, accommodation, and travel expenses? (if required)
Yes
No
Other (please specify)
10.
How long would you like the Alumni to attend?
Up to 1 hour
Up to 2 hours
Up to 4 hours
Other (please specify)
11.
Will you pay a speaker's fee if requested?
Yes
No
Other (please specify)
12.
Is there anything else you would like us to consider in reviewing this request?
