Board of Directors

Fields marked with an * are required

Contact Information

Name of Event*

Host Organization*

Contact Person*

Email*

Office Phone*

Cell Phone

Fax

Event Information

Description of Event*

Event Date*

Event Time*

Event Location*

Attire

Purpose for Visit*

Please attach a PDF of your invitation or agenda

Speech Information

Are remarks requested?

YesNo
Topic of Remarks

Length of Remarks

Will there be other speakers?

YesNo

If so, who and in what order will they speak?

Number of persons estimated to be in attendance

Dignitaries in the audience?*

YesNo
If so, who?

Will the press/media be attending?

YesNo
If so, which media groups will be represented?

Additional Notes