APHSA CEO Speaker Request Form

Speaker Request Form

Invite APHSA President & CEO Reggie Bicha, or other members of our team, to speak at your event.

Thank you for your interest in inviting Reggie Bicha, President and CEO of APHSA, or other staff members 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 to learn how he can contribute to your event.

*Speaker availability may vary depending on your event’s timing and focus. In some cases, other APHSA leaders or subject matter experts may be available. Please complete the information below to help us review your request.

Complete Form

"*" indicates required fields

Section 1: Organization & Contact Information

Primary Contact*

First Last

Email*

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 Speaker:*

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

Allotted Speaking Time (in minutes):*

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:

Section 5: Miscellaneous

Want to connect your work with ours? Whether you’d like to submit a proposal for one of our conferences, discuss a grant opportunity, or partner in another way, please let us know: