Paralympian Speakers Program Booking Form

Complete the form to book a Paralympian speaker for your event, free of charge.

Our Paralympian speakers have experience at a range of staff events including WHS training days and toolbox talks. They can also be booked to mark important days on the workplace calendar including National Road Safety Week, RU OK? Day, Safe Work Month, and International Day of People with Disability.

About your event

Company name*

ABN or icare policy number*

Event name*

Event date*

Start time*

End time*

Who is the audience?*

Speaker's role in the event*

Number of attendees*

Industry*

Address*

Dress code*

Please provide details for your disabled parking and access*

Speaker request

Please select your preferred speakers. Please note these are only preferences and not confirmed until icare sends through a final booking confirmation.

First preference*

Second preference*

Third preference*

Do you consent to icare promoting your Paralympian Speaker Program engagement via social media/media channels?* Yes No

How did you hear about the icare Paralympian Speakers Program?*

Please provide more detail on how you heard about the program*

About you

Full name*

Position title*

Contact phone*

Email*

I’d like to receive news and updates about the icare Paralympian Speakers program