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>.*
We store information you give us like your name and email address. We use this data to share personalised content and create a better experience for you. From time to time we will post offers of products and services tailored to you. We will not share your details with third parties. If you agree with our use of your personal information then you can check the box to the left.*
You can view our privacy policy here
CAPTCHA

Book a Speaker

Search

Image

Recent Posts

Quick Links

Calender of Events

Search