Schedule a Speaker

If you have found a speaker or topic of interest to you, please fill out the form below. David Mier, coordinator of our Government and Community Affairs team, will respond to your request. Due to the program’s popularity, we ask that you provide one to two months advance notice for speaking requests.

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Presentation Information

* Type of Organization:
If other, please specify:
* Topic of Presentation:
If other, please specify:
Speaker Name:
* Audience Size:
* Audience and Key Participants:
If other, please specify:
* Travel Expenses Covered:

Host Organization Contact Information

* Name and Brief Description of Host Organization:
* Website URL:
* Host Address:
* City:
* State:
* Zip:
* Host Contact Name:
* Email Address:
* Phone:

Logistical Information

* Event Date:
Select a date from the calendar.
Event Start Time:
Event End Time:
* Event Title:
* Event Objective:
Event Location
(If the event location is the same as Host Location, leave blank and skip to the Presentation Information section)
Address Line 1:

Address Line 2:
Presentation Information
* Type Of Presentation:
If other, please specify:
* Length of Requested Presentation:
* Audiovisual Capabilities:
* Media Coverage Expected:
Special Instructions or Notes
Please include anything else you feel is important here. Any additional details you can provide about the time your speaker is needed and how long you will need them present at your event (in the case of all-day conferences) will assist us as we look at our speakers' calendars.
Please copy and paste agenda into space below.
* indicates a required field