Speaker Request Form

    Official Speaker Request Form

    * Please note that this form must be completed within 14 days before actual scheduled event for processing and to ensure participation.
    For additional information or to speak with someone directly contact Scott Haggard (Government & External Affairs Director)
    404.893.2055 | [email protected] *

    Will the event be indoors or outdoors?
    Do you have any presentation needs?
    BioPhotoBusiness CardsInformational PublicationsPowerPoint Presentation

    Primary Event Contact Person

    Alternate Event Contact Person

    Local Media Contact Person

    What type of event?

    What is the role of the speaker at the event?
    Featured speakerWelcoming remarksForum or panel speaker

    Please provide details about the group/audience that would be helpful to the speaker

    Please provide list of key issues of importance to the organization and/or specific issues that the group would like the speaker to address.

    Please list other officials or special guests to attend, including name/titles.

    Estimated number of attendees

    Is the event open to the public?

    Will the media be in attendance?

    Who else will be speaking? Please include names/titles

    Approximate time the speaker will be introduced to speak.

    What takes place immediately before and after the speaker speaks?

    Who will introduce the speaker? (name/title)

    Who will be seated with the speaker? Please include names/titles.