Speaking Engagement Request Form

If you would like a Unitywater representative to speak at your event please fill out this request form. Unitywater will endeavour to accomodate all speaking requests.

1

Your Details

Name *
 
2
Position *
 
3
Contact phone number (Business hours) *
 
4
Mobile phone number
 
5
Email address
   
6

Organisation Details

Name *
 
7
Member Profile. E.g. Businesses, residents and ratepayers, environmental volunteers
 
8
Charter. (Brief description of the goals or charter of the organisation)
 
9
Website address
 
10

Proposed Speaking Engagement

Option 1:

Date *
 
11
Time *
 
12

Option 2:

Date
 
13
Time
 
14
Venue address *
 
15
Preferred topic/s *
 
16
Preferred speaker? e.g. CEO, Executive or subject matter expert.
 
17
Audience? (Who will be attending this event?) *
 
18
Numbers (Anticipated minimum numbers, please note an RSVP is required.) *
 
19
Additional comments
 
   
    Did You Know

  • Approximately one pool in every 20 has a leak! Even a minor leak can result in a major water loss.  Under pressure a tiny leak can lose more than 3000 litres a day.