Book A Speaker

PLEASE NOTE: this form is for booking AsIAm speakers for general events around autism awareness across a range of different settings and audiences.

If you wish to book an Secondary School Workshop for Autism, please fill out this form instead.

Point of contact information
First Name*
Surname*
This Form must be completed by a staff member who has their management's permission to formally request an AsIAm speaker. Please select your position (or most relevant) below)
Job Title*
Email Address*
Phone Number*
Address Line 1*
Address Line 2*
Address Line 3
Address Line 4
City/Town*
Workplace Information
Workplace Name*
Address Line 1*
Address Line 2*
Address Line 3
Address Line 4
City/Town*
County*
Eircode/Postcode
Phone Number*
Email Address*
Manager's Name*
Is this application approved by the managment and/or relevant personnel?*
- Yes
- No
Dates & Time
Preferred month*
Preferred day*
This will enable us to see if we can match a local speaker to your school.
Suitable Time*
Our workshops generally last 90 minutes long. please indicate appropriate class times on the days you have indicated
Event Specifics
Does your workplace have a sensory space for autistic employees and or clients?
- Yes
- No
Approx how many autistic individuals work at your business/organisation?
Other Information
Why do you want to receive AsIAm Autism Accreditation for your business/organisation?*
Where did you hear about AsIAm's Speaker Programme?*
I confirm that I have read and accept the <a href="https://asiam.ie/school-speakers-terms-conditions/">terms and conditions</a>.*
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