Event Request Form Home Event Request Form Event Name*Date of Event Date Format: MM slash DD slash YYYY Time of DayTime in h:am/pm format eg: 10amDate of the event is*ConfirmedFlexibleVenueLocation (City, State, Country)Contact InformationContact Name*Contact Email*PhoneEvent DetailsEvent purpose/objective(please include how your event aligns with gender equity/diversity in STEM)Ambassador’s roleEvent TypeEstimated audience size/number of attendeesWho is the audience?Other VIP attendees (if known)Who are the event sponsors?What steps have you taken to ensure diversity of speakers, panel members, etc.? (if applicable)Will media be present at the event/is any media planned?YesNoAre you able to provide travel and/or accommodation?YesNoEvent Background/Speaking NotesThe aim of this section is to provide the Women in STEM Ambassador with useful background information that will help her understanding of and inform her contribution to the event.