Invite BCRC To Your Event Request for breast cancer education speaker, resources, or event participationThank you for contacting the Breast Cancer Resource Center. We appreciate your interest in inviting BCRC to participate in your event. All meeting and speaking requests must be submitted through the web form below. Please include as much detail as possible in the form. We request that you submit this form along with supporting materials with as much notice as possible, preferably six weeks prior to the event date. Please note: we will consider all requests and will try our best to fulfill your request but we cannot guarantee a speaker. You will receive an email to schedule an initial call within five business days. Please direct additional questions to volunteer@bcrc.org. Thank you for the opportunity to engage with your audience.What is name of the contact person for your organization?(Required) First Last What is email address of the contact person for your organization?(Required) What is phone number of the contact person for your organization?(Required)Name of your Organization(Required) Organization Website Organization Description (tell us a little about your organization)(Required)What type of event is this?(Required) Community Fundraising Event [business or company fundraiser] Conference/Summit [BCRC will provide a subject matter expert to present at the conference/summit and/or provide a volunteer to offer materials at a table] Health Fair [BCRC will provide a volunteer to offer materials at a table] Outreach [Outreach to schools, groups, clubs, churches, etc. BCRC will provide a speaker to present on screening, breast cancer and treatment basics. We can also present on hereditary Breast Cancer “Bring Your Brave” and BCRC services] Roundtable [BCRC will provide a subject matter expert to participate in the topic presented at a healthcare professional roundtable] Webinar [BCRC will provide a subject matter expert to present at your webinar] Other Other, please specify [other types of events such as check presentations, lunch-n-learns, etc.] What language is your event:(Required) English Spanish Event Name(Required) Event Date(Required) MM slash DD slash YYYY Event Start Time(Required) Hours : Minutes AM PM AM/PM Event End Time(Required) Hours : Minutes AM PM AM/PM Speaking Start Time(Required) Hours : Minutes AM PM AM/PM Time Allotted for Speaker(Required) Event/Speaking Description(Required)Event/Speaking In-Person or Virtual(Required) In-Person (Central Texas only) Virtual Event/Speaking Location(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Deadline to receive speaker confirmation?(Required) MM slash DD slash YYYY Proposed Speaking Topic(s): (Please share any topics of interest that your audience would be interested in hearing about from our speaker) (choose all that apply)(Required) About BCRC [BCRC history/accomplishments, volunteer opportunities, fundraising] BCRC Support Services [patient navigation, Newly Diagnosed class, support groups, forums] Breast Education [what is breast cancer, mammography, treatment] Bring Your Brave [provides information about breast cancer to women younger than age 45] Other Other, Please specify Expected Audience Size?(Required)Audience Description? [Provide details of audience members (e.g. Employees, Parents, Students (ages)](Required)Materials the speaker needs to provide?(Required) Add RemoveWhat technology is available for the speaker? (laptop, projector, screen, tv)(Required) Add RemoveWill this event be formally recorded or published?(Required) Yes No Is there a fundraising component to this event?(Required) Yes No Is an award, certificate, check, gift or other item being presented to BCRC at your event? Do any promotional materials for the event include the speaker’s name or photo? Is this event open to the general public or available through an individual invitation only? 22580