Disability:IN Engagement Request Form

Thank you for your interest in a Disability Equality Index Deep Dive, Course Catalog Training, or Guest Speaker from Disability:IN. Please see below for descriptions and pricing. Note: If we are able to accept your request, you will receive an invoice, if applicable, from our team and will be connected with the person who will be fulfilling this engagement. If this opportunity is included in your Disability:IN Corporate Partnership or Inclusion Works benefits and has not yet been leveraged, you will not be charged for it. We will respond within one week of the request.

Regardless of whether this is included in your Corporate Partnership, or you are being invoiced, your company is responsible for fulfilling all accommodation requests including ASL and CART, for whoever on your team will join these events, either in-person or virtually.

Disability Equality Index Deep Dive ($5,000 for single market, $6,000 for multi-market)- a one-hour virtual session with a disability inclusion subject matter expert featuring company-specific, customized insights and recommendations for advancing your disability inclusion strategy based upon your Disability Equality Index results. Deep dive presentations are a complimentary partner benefit for Inclusion Works companies and Headlining/Presenting/Influencer level corporate partners.
Disability Inclusion Training from Disability:IN Course Catalog ($5,000)- a one-hour virtual session with a disability inclusion subject matter expert covering a topic of your choice from our Course Catalog with time for Q&A; includes one 30-minute prep session. Please note: Inclusion Works companies receive complimentary disability inclusion trainings as a part of their program benefits; Inclusion Works companies should contact their consultant directly to discuss training options and scheduling.
Disability:IN Guest Speaker ($2,000 for virtual or $2,500 plus travel and expenses for in-person)— Invitation for a member of the Disability:IN team to join a fireside chat or panel discussion; background materials and PowerPoint presentations not provided by Disability:IN. Please note: Inclusion Works companies receive complimentary guest speaker support as a part of their program benefits; Inclusion Works companies should contact their consultant directly to discuss speaking options and availability. Disability:IN corporate partners at the Headlining/Presenting levels receive 1 complimentary guest speaker as a part of their standard partnership benefits.

Company Name

First Name

Last Name

Title

Email Address (please use your corporate email)

Current Partnership Level

Engagement Opportunity

Select a Course Catalog Topic

Preferred Date/Time 1 (in Eastern time)

Preferred Date/Time 2 (in Eastern time)

Preferred Date/Time 3 (in Eastern time)

Is your speaking event virtual or in-person?

In-PersonVirtual

Event Virtual Platform

Event Location

Will this event be recorded?

YesNo

Will this event be recorded?

YesNo

Will this event be recorded?

YesNo

If the event is recorded, where will it be shared?

Anticipated number of attendees

Anticipated makeup of attendees (internal vs. external)

List of other speakers

Event Objective

Desired Topic

Desired Format (Panel, Q&A, Keynote, Etc.)

If this event is in-person, will your company be able to cover travel, hotel, and meal costs for the speaker?

Which Virtual Platform would you like to use?

Disability:IN Staff Member who sent you the form

Please let us know if you have any questions or comments!

Contact Information