Australian of the Year Appearance Request Form

If you are looking to get in contact with Neale Daniher or his family for an appearance for an event, please complete this form.

Fundraiser / Charity
Corporate
Professional
Awareness
School Visit
Other (Please specify)
Motivational
Informative
Leadership
Staff Engagement
Health & Wellness
Other (please specify)
Keynote Speaker (duration of speech ___________)
Panel Member
Q & A session
Fireside Chats (format between MC & Speaker)
Other (please specify)
Yes
No
Yes
No
less than 20
21 – 50
50 – 100
Over 200
Other (please specify)
Yes
No
Other (please specify)
Up to a 1 hour
Up to 2 hours
Up to 4 hours
Other (please specify)
Yes
No
Other (please specify)