Inclusion Team Speaking Event/Meeting Request Name of event* Date of the event* MM slash DD slash YYYY Length of time speaker required for*We are not always available to stay for the whole event. Please use this space to let us know the specific timing you would like us for Timing of event*Please indicate start and finish time of the event Full address of the event venue*Logistical arrangements*Parking and access arrangements etcEvent lead contact* First Last Contact tel number* Contact e-mail address* What is the purpose of the event?*Please provide details on what the purpose of the event is to help the team prepare. Please include extra background information on the event and your organisation.Please outline the brief for our participation at the event*Please describe what you would like the inclusion team participant to do: deliver a speech; deliver an intervention; be a panel member; run a workshop, etc. Is there a specific ask? Is a decision to be made? Please provide as much detail as possibleWhat are the desired learning outcomes for the event?*Let us know how you will benefit from our participation at this event and what a positive outcome would look likeHow many participants are you expecting?* Attendees*Please indicate the organisations you are expecting representation from Acute Trust Ambulance Trust Charity Community Pharmacy Community Trust Dentist GP Government Department University Local authority Independent Sector Mental Health Trust Arm’s Length Body CCG Optician Other Primary Care Specialist Trust Other If you clicked 'other' please describe here:Staff group* Clinical services Professional scientific and technical Administrative and clerical Allied health professional Estates and Ancillary Healthcare Scientists Medical and Dental Nursing and Midwifery Student Other Staff group* Executive (equivalent to ESM and above) Senior tier (equivalent to AfC 9-8c) Middle tier (equivalent to AfC 8b-7) Support roles (equivalent to AfC 6 and below) If you clicked 'other' please describe here:Programme/agendaPlease upload the event programme or agenda Drop files here or Select files Max. file size: 98 MB. Twitter hash tag for the event (if any)