Scientific Speaker Request

Fred Hutchinson Cancer Center is home to many world-renowned scientists. Please review the event support benefits to determine whether your event is eligible for a speaker. If it is eligible, please send your request at least six weeks prior to the event. Submitting a request does not guarantee that a speaker or representative can be provided. Note that speakers are limited to the greater Seattle/Eastside area.

Event organizer/primary contact full name * [* = required]

Organization/company * [* = required]

Primary contact address * [* = required]

City * [* = required]

State * [* = required]

ZIP code * [* = required]

Phone number * [* = required]

Email address * [* = required]

Event name * [* = required]

Expected number of attendees * [* = required]

Type of event (e.g. auction) * [* = required]

Event location * [* = required]

Event date * [* = required]

Event time * [* = required]

What type of speaker are you requesting? * [* = required]

What time will the requested speaker start his/her presentation? * [* = required]

How long is the speaker requested to speak? * [* = required]

Agreement

By entering my name below and submitting this proposal and agreement to Fred Hutchinson Cancer Center, I, as the event organizer, agree to comply with all Community Partner Event guidelines, terms and conditions that are part of this agreement. The event will be promoted and conducted in strict accordance with these terms, and the event organizer will obtain all necessary approvals from Fred Hutch.

Please review Community Partner Event guidelines, terms and conditions before submitting.

I agree to the above terms and conditions. * [* = required]

I agree

Full name * [* = required]

Today's date * [* = required]

Scientific Speaker Request

Contact Information

Event Details

Agreement