Safe Sport Speaker Request

Safe Sport Speaker Request Form

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CONTACT INFORMATION

First Name *

Last Name *

E-mail *

Phone *

Club Name *

LSC

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EVENT INFORMATION

Event Date * +

Event Location *

Type of Event *

House of Delegates	Swimposium
Leadership meeting	Zone Event
LSC Event	Team meeting
Chairs meeting	Other Other

Audience (select all that apply) *

Coaches	Athletes
Parents	Volunteers
Officials	Other Other

Number of Anticipated Attendees *

Topic Requested (all that apply) *

Scenario-based training	Safe Sport 101
Bullying and Peer Conflict	Dynamics of power-based abuse
Other Other

Speaker Requested *

Safe Sport staff member	Safe Sport volunteer
Local expert	Other Other

My budget for this event is: *

$0

$1 - $500

$500 - $1,000

$1000+

*Note: No request will be discarded due to lack of funds. USA Swimming can supplement the LSC or club budget to bring Safe Sport education at the local level, or USA Swimming can help connect you with an expert in your area.

Additional Comments *

Click the SUBMIT button when you have completed the form. You will receive an e-mail copy of your submission.