Google Speaker Request Form

Please complete and submit the form below to request a Google speaker for your upcoming event. Due to scheduling constraints, we typically will not be able to accommodate requests for Google speakers less than 1 month or more than 6 months in advance of an event. Please note that while Googlers are always excited at the chance to speak to our users, customers, and partners at events, we receive such a high volume of requests that it's impossible for us to send a Googler to every worthwhile event. Thanks so much for your interest.

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Section I: Contact info
Name: *
Company/Organization: *
Title: *
Phone number: *
Email address: *
Organization or event website URL: *
Section II: About the Conference
Confirmation deadline: *
Please use the format mm/dd/yyyy.
Event name: *
Event theme: *
City: *
State: *
Country: *
Start date of event: *
Please use the format mm/dd/yyyy.
End date of event: *
Please use the format mm/dd/yyyy.
Event sponsors: *
Information about your organization: *
How long has the event been in production: *
If this is not a first-time event, please provide a list of previous speakers: *
Has a Googler ever spoken at your event in the past? *
- Yes
- No
If you selected Yes to the question above, please provide a list of Googlers who have spoken at your previous events: *
Conference agenda: *
If there is a website with your agenda, enter the URL. Otherwise, paste your full agenda here.
Invited speakers: *
Confirmed speakers: *
Number of expected attendees: *
Audience demographics: *
Section III: About the Opportunity
Requested Google representative: *
If the Google representative of your choice is not available, would you accept an alternative speaker? *
- No
- Yes
If Yes, please enter the name of your alternate choice:
Why do you want Google to participate? *
Date of speech: *
Please use the format mm/dd/yyyy.
What time will the speech start? *
Please enter in hh:mm am/pm format.
What time will the speech end? *
Please enter in hh:mm am/pm format.
Is this time slot flexible and/or tentative? *
- No
- Yes
If Yes, please explain below.
Format of talk: *
- Keynote
- Presentation
- Fireside chat
- Panel (see below)
- Other (see below)
If Panel, please list other panelists. If Other, please describe format.
Topic of keynote, presentation, panel or fireside chat: *
Plenary or breakout session? *
- Plenary
- Breakout
Q&A; included? *
- Yes
- No
Name of moderator (if applicable): *
If you are requesting Googlers for more than one panel or keynote, please enter other session info here:
Slide presentation required? *
- No
- Yes
- Optional
Are press invited? *
- No
- Yes
If Yes, please provide a list of invited press.
If you answered yes to the question above, is the session on the record?
- Yes
- No
Will the session be recorded?
- No
- Yes
Is there any other information you would like us to know to evaluate this request?

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