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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 & Founder
Kevin Roy, Chief Policy Officer
Jen Velez, Chief Impact Officer
Matthew Stefanko, Director, National Stigma Initiative
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+
Happy Pride Month!
With your help, we can ensure the LGBTQ+ community has access to addiction treatment that suits their needs and fight the stigma facing queer and trans people with SUD.
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