Shatterproof Speaker Request Host Organization Name* Description* Street Address* City* State/Province* Zip Code* Website* Contact Name* Contact Email* Contact Phone* Presentation Details Name of requested Shatterproof Speaker* Gary Mendell, CEO Kevin Roy, Chief Policy Officer Kirsten Seckler, Chief Marketing Officer Shannon Biello, VP of Treatment Standards and Quality, ATLAS Rachael Cooper, Senior Director, Stigma Shatterproof Ambassador: A diverse group of individuals impacted by SUD from all over the US who are available to speak at community events. Please indicate the town and state your request is for in the event location field below and we will do our best to meet your needs. Presentation Length* Will you cover the speaker's travel expenses and/or offer an honorarium* Yes No Event Information Event Title Event Time Event Date* Event Location Agenda for the Event/Conference Audience & Key Participants Anticipated Audience Size 10-50 51-100 101-150 201-1000 1000+
