Positive Speakers Bureau Booking Form

Please complete the form below to book a Positive Speaker. If you are booking several talks on the same day at the same venue, please place these details on the one form. If you are booking several talks on different dates, please enter your bookings one at a time.
(*) indicates a response is required
Have you used the PSB before?
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How did you hear about the PSB?
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Organisation name(*)
Please enter the name of your agency, organisation or group

Type of organisation
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Your First name
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Your Surname
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Your position
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Contact phone
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Mobile phone
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Fax
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Email
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Booking details

How many talks to you want to book?
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Choose a date
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Choose a time
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Talk duration
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Number of Speakers
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How many speakers do you require?

Audience will be
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Est Audience Total
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Please indicate the estimated number of audience participants

Is this booking part of a school PDHPE syllabus
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Is this talk(s) part of a school Cross Roads syllabus
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Talk Content(*)
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Please indicate the requirements of the talk (Content, themes, key messages, learning outcomes for the audience etc). If you have the name of a particular speaker, please include it here.

Venue Name(*)
Please provide full details including building name/room number if applicable.

Please provide full details including building name/room number if applicable.

Venue Address(*)
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Venue Suburb(*)
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Venue Suburb

State
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Venue Postcode(*)
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Knowledge on HIV/AIDS issues
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What is the audience’s level of understanding and knowledge on HIV/AIDS issues?

Audience attitudes
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What are the general attitudes of the audience towards gay men or people with HIV?

Invoice Details

ABN(*)
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Invoice Address(*)
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Address to appear on the Invoice

Suburb(*)
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State(*)
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Postcode(*)
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Email(*)
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Enter the mailing & email address of the person responsible for authority & payment of the invoice – payments are due within 14 days

Booking organiser's contact details

First and Surname(*)
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Organiser's Full Name

Contact Phone(*)
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Contact number for booking organiser if there are any questions about this booking

Location: Suite 5.2, Level 5, 414 Elizabeth Street, Surry Hills NSW 2010
Postal: PO Box 831, Darlinghurst NSW 1300

Telephone: 02 9206 2177 or 1800 245 677 (freecall)
TTY: 131 450    Fax: 02 9211 5672

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