Speakers Bureau Request Form

* denotes required fields

CONTACT INFORMATION

* Contact Person:

* Contact's Email address:

* Contact's Phone Number:

Contact's Fax Number:

EVENT INFORMATION

* 1. Group/Sponsor:

* 2. Event Name:

* 3. Event Location:

* 4. Date of Event:

(mm/dd/yyyy)

* 5. Time of Event:

(12:00pm)

* 6. Recurrence:

* 7. Speech topic:

* 8. Purpose of event:

2000 characters max.

* 9. Number of Attendees expected:

* 10. Audience Demography:

Academic Professional	Aviation Organizations
Business Groups (US)	Civic Organizations
DOA/ Airport Personnel	Elected/ Appointed Officials
International Business	Media
Residents Near Airport	Students
Suppliers/ Contractors	Travel & Tourism

* 11. Length of Presentation (in minutes):

* 12. Agenda Topics:

* 13. Will there be a Q & A aftwerwards:

Yes No

* 14. Presentation method requested:

* 15. Audio Visual Equipment Provided by Requestor:

* 16. Is a bio needed for speaker introductions?

Yes No

* 17. Send a copy of PowerPoint or handouts in advance?

Yes No

18. What is the organization's web address?

19. Comments

2000 characters max.

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