Audience Size (minimum 20)
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Date and Time of Speech
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First
preference
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Date:
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Time:
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Second
preference
|
Date:
|
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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Contact Information
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Name
|
First:
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Last:
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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 from
downtown Cleveland
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Parking arrangements
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Audience Type
|
|
|
|
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Speech
|
| |
Keynote
Workshop
Lecture
|
Other
|
| |
| |
Breakfast
Lunch
Dinner
|
Other
|
| |
Length of Speech
|
30 minutes
45 minutes
1 hour
|
Other
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Q&A
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During speech
After speech
|
Other
|
| |
Length
of Q&A
|
15 minutes
30 minutes
|
Other
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Panel discussion
|
|
|
Yes
No
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Panelist name(s) and affiliations
|
| |
Length of
panel discussion
|
30 minutes
45 minutes
1 hour
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Other
|
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Moderator
|
|
|
Yes
No
|
Panelist name(s) and affiliations
|
|
Media coverage
|
| |
No
Yes, please explain
Possible, please explain
|
|
Event Agenda and/or Press Release
|
|
Please email agenda and/or press release to patricia.a.demaioribus@clev.frb.org
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AV Equipment Availability
|
(select one
or more)
|
Laptop Projector Screen Microphone Podium
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|
How did you learn about our Speakers Bureau?
|
(select one
or more)
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Website
Referral
|
Other, please explain:
|
| |
