Schedule a Speaker

Find a speaker or topic that interests you? Simply fill out this form and David Mier, Coordinator of Government and Community Affairs, with respond to your request.

Due to the popularity of this program and the impacted schedules of our speakers, we ask that you provide 1-2 months advance notice for speaking requests.

POC Name: 

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:
(xxx-xxx-xxxx)

Logistical Information

* Event Date:
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:
City:
State:
Zip:
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.
Agenda
Please copy and paste agenda into space below.
* indicates a required field