*Audience Size (minimum 25)
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Date and Time of Speech |
| *First preference |
*Date:
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*Time:
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| Second preference |
Date:
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Time:
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*Speaker Arrival Time
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Information About Your Organization
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*Organization name
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*Web address
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| *Briefly describe your organization |
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Group Type:
hold CTRL + click to select more than one |
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Contact Information
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*First Name:
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*Last Name:
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Title:
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*Phone:
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*Email:
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Fax:
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Topic(s) of Interest
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| *First |
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| Second |
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| Third |
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Event Information
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| *Location |
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| *Address |
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*City
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*State
*Zip
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| Phone |
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| Directions |
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| Parking arrangements |
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*Audience Type |
| Describe |
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Speech |
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Welcome
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Introduction
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Keynote
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Workshop
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| Remarks |
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| Other
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*Program Format
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Breakfast
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Lunch
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Dinner
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None
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Other
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Length of Speech
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30 minutes
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45 minutes
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1 hour
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Other
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*Q&A
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During speech
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After speech
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None
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Length of Q&A
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15 minutes
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30 minutes
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Other
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Panel discussion
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Yes
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No
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Panelist names, titles and organizations
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Length of Panel discussion
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30 minutes
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45 minutes
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1 hour
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None
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Other
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Moderator
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Yes
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No
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*Event open to news media
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Open to public or media Comments:
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Possible Comments:
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Not open to public or media
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*Event to be broadcast?
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Yes, please explain
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No
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Speaker bio needed?
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Yes
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No
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Speaker photo needed?
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Yes
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No
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Event Agenda and/or Press Release
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Please email agenda and/or press release to patricia.a.demaioribus@clev.frb.org
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A/V Equipment Available
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(select one or more)
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Laptop
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Podium with microphone
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Projector
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Screen
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Lapel microphone
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Wireless mouse
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Wide-screen TV monitor
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How did you learn about our Speakers Bureau?
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(select one or more)
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Website
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Referral
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If referral, please explain:
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