Speaker request form

Please fill in the below fields to request a speaker. Call 1300 65 65 85 should you have any queries.

Once the form has been completed and submitted, our team will work on securing a suitable speaker – every endeavour will be made for this to be done as quickly as possible, however when there is a higher volume of speaker requests and depending on location and topic, this may take a little longer.

Your details

Event details











(Inc. audience numbers, have you had a Cancer Council Victoria Speaker before.)

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