Speaking Request Contact InformationFull Name(Required)TitleInstitution / Organization(Required)Website Email Address(Required) Event DetailsEvent Name/Theme(Required)Event Location(Required)The location should include Venue, City, and StateEvent Start Time Hours : Minutes AM PM AM/PM Event End Time Hours : Minutes AM PM AM/PM President's participation/involvement requested from:Start Time Hours : Minutes AM PM AM/PM NOTE: The times requested for the President's participation should be as exact as possible, as we may schedule multiple events the same day.End Time Hours : Minutes AM PM AM/PM NOTE: The times requested for the President's participation should be as exact as possible, as we may schedule multiple events the same day.Attire(Required) Business Professional Business Casual Casual Type of Event(Required)Annual MeetingRegional MeetingLunchBanquetPanelOtherPlease DescribeIs the President being requested to speak?(Required) Yes No Please indicate what level of participation the President would have in your event:What is the group's objective in having the President speak or attend?Does the group have any special interests, topics or concerns that should be addressed?Anticipated number of attendees?(Required)Should the remarks be formal or conversational? Formal Conversational Please describe the audience:(Required)Is there anything else that you would like for us to know about your event?Travel Details/ArrangementsWhat are the guidelines for travel budget and arrangements?Will you handle arrangements?(Required) Yes No Onsite event contact name and cell phone numberOther notesCAPTCHA
