JXN Water

Request a JXN Water Speaker

JXN Water Speaker Request Form

Thank you for contacting JXN Water. We appreciate your interest in inviting JXN Water to participate in your event. All meeting and speaking requests must be submitted through the web form below. We request that you submit this form along with any supporting materials a minimum of four weeks and preferably 12-weeks prior to the event date. Please note that all requests will be reviewed before a final determination is made. Please allow 3-5 business days for decisions to be made.For any questions, please contact Ameerah Palacios at [email protected].

Speaker Requested(Required)

Speaking Topic

Event Name

Date of Your Event

Audience Size(Required)

Please enter a number greater than or equal to 15.

The minimum audience is 15 or more. For smaller groups or 1:1 meeting requests please email [email protected].

Speaking Start Time

Is speaking time flexible?(Required)

Event Type and Presentation Format(Required)

Special Event/Awards Ceremony

Board Meeting or Briefing

Conference/Summit Keynote or Panel

Neighborhood Meeting/Reception

Other

Event Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Honorable Guests (if applicable)

(List names and titles of members of Congress, heads of state, CEOs, or other VIPs participating in, or attending your event)

Event Agenda(Required)

Max. file size: 50 MB.

Please upload the agenda for your event to give JXN Water an idea of how much time you will give the speaker.

Will you accept a pre-recorded message if your speaker is not available in-person?(Required)

Will the speech be followed by a Q&A Session?(Required)

Will a resource table be available if the speaker brings JXN Water materials to hand out to attendees?(Required)

Will media be invited to this event?(Required)

Your Name(Required)

First Last

Your Title(Required)

Your Organization Description and Website(Required)

Your Email(Required)

Your Phone Number(Required)

Comments

This field is for validation purposes and should be left unchanged.