APHSA CEO Speaker Request Form

Speaker Request Form:
Reggie Bicha, APHSA President & CEO

Thank you for your interest in inviting Reggie Bicha, President and CEO of APHSA, to speak at your event. With a background as a social worker, administrator, and nationally recognized leader in child welfare, early childhood, and human services, Bicha connects lessons from the past with forward-looking solutions.

View Bicha’s speaker sheet and see how he can contribute to your event.

Complete Form

« * » indique les champs nécessaires

Section 1: Organization & Contact Information

Primary Contact*

Prénom Nom

E-mail*

Phone*

Website*

Section 2: Event Details

Event Title:*

Event Type (Conference, Webinar, etc.):*

Event Theme/Focus:*

Expected Audience (size & profile):*

Event Date(s) & Time(s):*

Event Location (City/State or Virtual):*

Other Confirmed Speakers:*

Section 3: Speaking Request

Requested Role for CEO:*

In what way could the CEO best contribute to your event—as a keynote speaker, panel guest, or in another capacity?

Allotted Speaking Time (in minutes):*

Veuillez saisir un nombre entre 45 et 180.

Proposed Topic(s):*

Q&A or Interactive Segment?*

Honorarium or Travel Support Offered?*

Section 4: Logistics & Submission

Event Host Responsibilities (AV, travel, etc.):*

Recording/Media Plans:*

Additional Notes:

Speaker Request Form: Reggie Bicha, APHSA President & CEO