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Public Speaking Requests

Public Speaking Requests

Event Organizer
Name of Organization Submitting Request:
Event Sponsor(s):
For Profit/Not for Profit
Coordinator/Point of Contact:*
(Name, title, office phone, cell phone)
Coordinator Email Address*
Event Details
Event Name/Title:
Event Location:
Event Date:
MM slash DD slash YYYY
Event Time:

: Hours

Minutes

AM/PM
Event Type:
(Conference, dinner, small group, etc.)
Event Purpose/Goal:
Presentation/Speech Details
Requested Topic:
Presentation Format:
(Keynote address, roundtable, panel, etc.)
Expected Duration:
(30 minutes, 1 hour, etc.)
Questions and Answer:
- Yes
- No
(Will the speech be followed by a Q&A session?)
Audience Details
Audience:
(Approximate size of audience. Also briefly describe its make-up and if membership is required to attend.)
Honorable Guests:
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