Speaker Request Form

In order to effectively prioritize your request, please complete as much information as possible.

Host Organization *

Requestor Name & Title/Affiliation *

Requestor contact information (email AND cell phone) *

EVENT DETAILS

Name of event *

Event date, time and location *

Event purpose & target audience *

What is this meeting about and what is the audience of attendees - newcomers to the area, business owners, high school FBLA members, etc.

Number of expected attendees *

Special guests in attendance *

PRESENTATION DETAILS

What topic are you hoping to hear about? *

Please provide as much detail or insight as possible to help ensure we have an appropriate understanding of expectations.

Total running time of speech/presentation *

Who will introduce April in the program?

Where will April be seated and who will be seated with her?

Please include names, organizational affiliation and business information. Ex. Michael Collins, Chamber Board Chairman and owner of Total Computer Solutions, etc.

Are April's bio and headshot needed? *

PARKING & DIRECTONS

Please provide details on parking, venue entrance, and any directional information necessary.

RUN OF SHOW

Please provide a run of show for the event including expected arrival time, order of events/program, anticipated end time, etc. *

ADDITIONAL INFO

Please provide any additional information that may be helpful to maximize the experience.

Robins Regional Chamber

Speaker Request Form

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