PSB booking enquiry

Please complete the form below to indicate your interest in hosting a Positive Speakers' Bureau talk. You can book up to five talks on this form.

Your contact details

Organisation name:

Type of organisation:

Your name:

Your position:

Phone:

Mobile:

Fax:

Email:

We need at least one phone number and an email address to process your request

ABN:

Address for invoicing:

Enter the mailing address to which we should send the invoice for this booking

Have you used the PSB before?

Yes No Not sure

How did you hear about the PSB?

Booking details

How many talks do you want to book?

1 2 3 4 5

Note: One talk equals one hour with no more than 45 students. If you need to book more than five talks, please contact the PSB for assistance

Booking no. 1

Date:

Time:

Talk duration:

Venue:

Please provide full details including building name, room number and address

Will the audience be...

Please indicate the gender breakup of the audience for this talk

About the audience(s)

The information in this section is used as a briefing to the allocated speaker. Please provide as much detail as possible – this will ensure the speaker is able to tailor the discussion to the audience.

Please indicate below any unusual or individual requirements regarding this booking:

To your knowledge is there anybody in the audience who may have had or has a friend or relative who has been affected by HIV/AIDS?

Yes No/unsure

What is the audience's level of understanding and knowledge on “Safe Sex” and HIV/AIDS transmission issues?

I am aware that 85% of People Living with HIV/AIDS in Australia are gay males and therefore there is a high probability that the appointed speaker may be a gay man.

What are the general attitudes of the group(s) towards gay men and women?

Booking agreement

Fees applicable to this booking:

The basic PSB fee structure is:

Booking Fee: $40 (Per booking, retained if cancelled within 1 week)
Speakers Fee: $80 (Based on 1 hour)
Travel:
- Metro: $20.00
- Outer Metro: $30.00
- Rural $0.53 per km
GST: 10% is charged to all booking, speakers & travel fees.

Notes:

Where applicable, accommodation, food and misc. expenses (such as the cost of child care) are the client's responsibility and subject to negotiation.
The PSB is dedicated to addressing the widest audience possible and fees are negotiable where financial constraints would limit your organisations access to this service.

Agreement:

I request that the PSB provide a talk at the schedule of fees as stated above or those as negotiated with the PSB Community Development Officer on the dates and times as indicated in this form.

I agree to inform the PSB Community Development Officer without delay any changes after the booking(s) are confirmed.

Please tick this box:

I agree to the terms stated above and request that this booking be made.