Médecins Sans Frontières Speaker/Event Request Form

Please take the time to fill in as many details as you can in the request form below. This will help us at Médecins Sans Frontières to respond to your request promptly.
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In which country will your event be held? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Médecins Sans Frontières respects your right to protection of your personal information. All information collected on this request form will be used only to organise a speaker for your event and will be held in accordance with the MédecinsSans Frontières Privacy Policy available in full at https://msf.org.nz/privacy-policy

Médecins Sans Frontières respects your right to protection of your personal information. All information collected on this request form will be used only to organise a speaker for your event and will be held in accordance with the Médecins Sans Frontières Privacy Policy available in full at https://msf.org.au/privacy-policy-condensed

This is a Médecins Sans Frontières New Zealand Application. Please refer to the Médecins Sans Frontières New Zealand Privacy Policy for relevant information.

This form is through a 3rd party website based in the USA. Please also read the Cognito Forms Privacy Policy before proceeding to disclose any personal data.

This is a Médecins Sans Frontières Australia Application. Please refer to the Médecins Sans Frontières Australia Privacy Policy for relevant information.

This form is through a 3rd party website based in the USA. Please also read the Cognito Forms Privacy Policy before proceeding to disclose any personal data.

Do you intend to fundraise for Médecins Sans Frontières at this event? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you filled out Médecins Sans Frontières Community Fundraising Application? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please note that fundraising for Médecins Sans Frontières New Zealand requires special approval. Fill out your email below to receive information about fundraising for Médecins Sans Frontières New Zealand before requesting a speaker/attendee at your event.

Please note that fundraising for Médecins Sans Frontières Australia requires special approval. Fill out your email below to receive information about fundraising for Médecins Sans Frontières Australia before requesting a speaker/attendee at your event.

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ORGANISATION DETAILS

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EVENT DETAILS

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EVENT LOCATION
Has the event location been confirmed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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My event is virtual? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please proceed to the next page. MSF will be in contact soon to confirm the event location details.

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EVENT DETAILS

SPEAKER/ATTENDEE REQUIREMENTS

You may select to have a speaker at your event, however, if you have an event that does not require a speaker you may simply request for someone to attend the event, ie. An MSF representative to attend a Career Expo.

Do you require a speaker? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Select the type of speaker you would prefer {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Select the preferred session type for the speaker {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you confirmed the event date/s and times? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

MSF will be in contact soon to confirm the event dates and times.

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Equipment Available {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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{# pageNumbers}

EVENT ORGANISER CONTACT DETAILS

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OTHER DETAILS

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MSFA Strategic Outcome {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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{# pageNumbers}

Médecins Sans Frontières Speaker/Event Request Form

In which country will your event be held? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Médecins Sans Frontières respects your right to protection of your personal information. All information collected on this request form will be used only to organise a speaker for your event and will be held in accordance with the MédecinsSans Frontières Privacy Policy available in full at https://msf.org.nz/privacy-policy

Médecins Sans Frontières respects your right to protection of your personal information. All information collected on this request form will be used only to organise a speaker for your event and will be held in accordance with the Médecins Sans Frontières Privacy Policy available in full at https://msf.org.au/privacy-policy-condensed

This is a Médecins Sans Frontières New Zealand Application. Please refer to the Médecins Sans Frontières New Zealand Privacy Policy for relevant information.

This form is through a 3rd party website based in the USA. Please also read the Cognito Forms Privacy Policy before proceeding to disclose any personal data.

This is a Médecins Sans Frontières Australia Application. Please refer to the Médecins Sans Frontières Australia Privacy Policy for relevant information.

This form is through a 3rd party website based in the USA. Please also read the Cognito Forms Privacy Policy before proceeding to disclose any personal data.

Do you intend to fundraise for Médecins Sans Frontières at this event? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you filled out Médecins Sans Frontières Community Fundraising Application? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Please note that fundraising for Médecins Sans Frontières New Zealand requires special approval. Fill out your email below to receive information about fundraising for Médecins Sans Frontières New Zealand before requesting a speaker/attendee at your event.

Please note that fundraising for Médecins Sans Frontières Australia requires special approval. Fill out your email below to receive information about fundraising for Médecins Sans Frontières Australia before requesting a speaker/attendee at your event.

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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ORGANISATION DETAILS

Organisation Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Website {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please give us a brief description of your organisation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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EVENT DETAILS

Event Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Brief Description of Event {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Audience Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Event Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If selected 'other' audience type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If selected 'other' event type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Estimated Number of Attendees {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
EVENT LOCATION
Has the event location been confirmed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
My event is virtual? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
What platform will you host your virtual event on? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Event Street Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Event Street Address Line 2 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
City/Suburb {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
State/Province/Region {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Post Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Please proceed to the next page. MSF will be in contact soon to confirm the event location details.

EVENT DETAILS

SPEAKER/ATTENDEE REQUIREMENTS

You may select to have a speaker at your event, however, if you have an event that does not require a speaker you may simply request for someone to attend the event, ie. An MSF representative to attend a Career Expo.

Do you require a speaker? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Select the type of speaker you would prefer {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Select the preferred session type for the speaker {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
List speaker topics - if speaker required {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you confirmed the event date/s and times? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

MSF will be in contact soon to confirm the event dates and times.

Event Date - Attendance Required {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Event Time - Attendance Required From {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Event Time - Attendance Required Until {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Time allocated for Speaker {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Speaker/Attendee Role {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Speaker/Attendee Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Equipment Available {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Other Equipment Available {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Resources Required {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

EVENT ORGANISER CONTACT DETAILS

First Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Last Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Position Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Mobile Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Work Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

OTHER DETAILS

Where did you hear about MSF? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please indicate any other event information you want to communicate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you have any event flyers or brochures to attach? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}

{ binding firstError.message }
Notes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Application Status {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
MSFA Strategic Outcome {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
The email has been sent.

Your progress has been saved.

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Médecins Sans Frontières Speaker/Event Request Form

Please take the time to fill in as many details as you can in the request form below. This will help us at Médecins Sans Frontières to respond to your request promptly.
In which country will your event be held? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Médecins Sans Frontières respects your right to protection of your personal information. All information collected on this request form will be used only to organise a speaker for your event and will be held in accordance with the MédecinsSans Frontières Privacy Policy available in full at https://msf.org.nz/privacy-policy

Médecins Sans Frontières respects your right to protection of your personal information. All information collected on this request form will be used only to organise a speaker for your event and will be held in accordance with the Médecins Sans Frontières Privacy Policy available in full at https://msf.org.au/privacy-policy-condensed

This is a Médecins Sans Frontières New Zealand Application. Please refer to the Médecins Sans Frontières New Zealand Privacy Policy for relevant information.

This form is through a 3rd party website based in the USA. Please also read the Cognito Forms Privacy Policy before proceeding to disclose any personal data.

This is a Médecins Sans Frontières Australia Application. Please refer to the Médecins Sans Frontières Australia Privacy Policy for relevant information.

This form is through a 3rd party website based in the USA. Please also read the Cognito Forms Privacy Policy before proceeding to disclose any personal data.

Do you intend to fundraise for Médecins Sans Frontières at this event? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you filled out Médecins Sans Frontières Community Fundraising Application? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Please note that fundraising for Médecins Sans Frontières New Zealand requires special approval. Fill out your email below to receive information about fundraising for Médecins Sans Frontières New Zealand before requesting a speaker/attendee at your event.

Please note that fundraising for Médecins Sans Frontières Australia requires special approval. Fill out your email below to receive information about fundraising for Médecins Sans Frontières Australia before requesting a speaker/attendee at your event.

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

ORGANISATION DETAILS

Organisation Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Website {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please give us a brief description of your organisation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

EVENT DETAILS

Event Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Brief Description of Event {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Audience Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Event Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If selected 'other' audience type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If selected 'other' event type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Estimated Number of Attendees {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
EVENT LOCATION
Has the event location been confirmed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
My event is virtual? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
What platform will you host your virtual event on? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Event Street Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Event Street Address Line 2 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
City/Suburb {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
State/Province/Region {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Post Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Please proceed to the next page. MSF will be in contact soon to confirm the event location details.

EVENT DETAILS

SPEAKER/ATTENDEE REQUIREMENTS

You may select to have a speaker at your event, however, if you have an event that does not require a speaker you may simply request for someone to attend the event, ie. An MSF representative to attend a Career Expo.

Do you require a speaker? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Select the type of speaker you would prefer {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Select the preferred session type for the speaker {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
List speaker topics - if speaker required {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you confirmed the event date/s and times? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

MSF will be in contact soon to confirm the event dates and times.

Event Date - Attendance Required {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Event Time - Attendance Required From {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Event Time - Attendance Required Until {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Time allocated for Speaker {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Speaker/Attendee Role {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Speaker/Attendee Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Equipment Available {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Other Equipment Available {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Resources Required {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

EVENT ORGANISER CONTACT DETAILS

First Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Last Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Position Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Mobile Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Work Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

OTHER DETAILS

Where did you hear about MSF? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please indicate any other event information you want to communicate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you have any event flyers or brochures to attach? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}

{ binding firstError.message }
Notes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Application Status {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
MSFA Strategic Outcome {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }