Requested length of time for the speaking engagement. If a PowerPoint will be used during a presentation, is it acceptable for the presentation to be provided via flash drive? If a PowerPoint will be used during a presentation, will a projector and a computer be provided for the speaker?

Due to the Covid - 19 pandemic, we are only able to accept invitations to virtual events. Please use this form, but skip any travel details. Please upload the Program Booklet for the Event. Please upload the "Schedule at a Glance".

Information needed from NHSA please check all that apply Speaker Bio Flight Itinerary Photo of the Speaker. Additional Information and Requests. Please list major airports near the hotel where the speaker will be staying. Is there an existing hotel reservation for the requested speaker?

Will a reservation be made for the requested speaker? Please provide the hotel confirmation number:. Hotel where the speaker will be staying. Hotel Address. Hotel City. Hotel State Please select Hotel Zip Code. Does the hotel have shuttle service to and from the airport?

If yes, please provide the contact information for the Hotel Shuttle. If no, will ground will ground transportation be provided from the airport to the hotel?

Organization Description. Organization Website. Event Name. Event Topic. Event Description. Event Start Event Start: Date. Event End Event End: Date. Speaking Date Speaking Date: Date. Deadline to receive speaker confirmation Deadline to receive speaker confirmation: Date.

Speaking Start Time. Is speaking start time flexible? Speaking End Time. Event Time Zone. Speaking Duration - Select - Attend Only 5 Min 10 Min 15 Min 20 min 30 min 45 min 60 min. Address Type - Select - Breakout Session Fireside Chat Interview Keynote Plenary Session Panel Discussion Remarks Opening, Closing Other….

Speaking Topic Details. Event Venue. Event Address. Event Address 2. Event Address 1 Event State - None - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Canada, Europe, Africa, or Middle East Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming.

Barthélemy St. Helena St. Lucia St. Martin St. Outlying Islands U. Audience Size. Formally Recorded or Published? What types of media are invited to the event? Are any other HHS officials speaking at this event? Speaker Participation Format keynote speaker, panel member, etc.

Hate CCRU Community Conflict Resolution Unit Civil Rights "You th have rights! Please add more information about the training being requested if necessary.

If yes, due date needed. Travel Information Recommendation s for hotel accommodations that provide government rates.

Hotel Name 1. Phone Number. Hotel Name 2. Closest Airport to the Event. On-Site Contact During Event.

Please complete as much information as possible regarding the event and speaker requirements and then hit the SUBMIT FORM button to send To assist us in serving your needs and effectively representing AACTE, we ask that you complete this form as part of any invitation for the President to speak To help us make the most informed decision about your request for a Patagonia representative to speak, please fill out the below speaker request form. Please

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Speaking Engagement Request Form - We request that you submit this form along with any supporting materials a minimum of four weeks and preferably weeks prior to the event date Please complete as much information as possible regarding the event and speaker requirements and then hit the SUBMIT FORM button to send To assist us in serving your needs and effectively representing AACTE, we ask that you complete this form as part of any invitation for the President to speak To help us make the most informed decision about your request for a Patagonia representative to speak, please fill out the below speaker request form. Please

State Association Regional Association HS Program Other. If other, please provide details below. Name of Event please include a brief description.

Event Start Date. Event End Date. Expected number of attendees. Venue Name. Venue Address. Venue City. Venue State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau.

Venue Zip Code. Preferred Speaker s Please select Yasmina Vinci, Executive Director Thomas Sheridan, Deputy Director Dr. Deborah Bergeron, Deputy Director for Community Engagement and Innovation Kent Mitchell, Senior Director of State Affairs Kathleen Havey, Senior Government Affairs Advisor Victoria Jones, Seniior Director of Data.

If the preferred speaker isn't available, will you accept another speaker from NHSA? Select an alternate speaker below Please select Deborah Bergeron, Deputy Director for Community Engagement and Innovation Kent Mitchell, Senior Director of State Affairs Kathleen Havey, Senior Government Affairs Advisor Victoria Jones, Senior Director of Data.

Date of Speaking Engagement. Time Slot of Speaking Engagement. Speaker's Role for Speaking Engagement Please select Keynote Moderator Panelist Presenter Meeting Participant Other Strategic Planning Advocacy Events.

Requested length of time for the speaking engagement. If a PowerPoint will be used during a presentation, is it acceptable for the presentation to be provided via flash drive? If a PowerPoint will be used during a presentation, will a projector and a computer be provided for the speaker?

Due to the Covid - 19 pandemic, we are only able to accept invitations to virtual events. Please use this form, but skip any travel details. Please upload the Program Booklet for the Event. Please upload the "Schedule at a Glance". Information needed from NHSA please check all that apply Speaker Bio Flight Itinerary Photo of the Speaker.

Additional Information and Requests. Please list major airports near the hotel where the speaker will be staying. Please include room and floor number, special directions, or any additional details. If exact number is unknown, please provide an estimated number.

Choose an Item Yes No. If a program is available, please attach the document below. If you will have the program ready at a later date, you may email the program to Sylvia.

Bowen birminghamal. Drop files here or Select files. Home About Live City Council Work City Directory Play Contact. Facebook Twitter YouTube Instagram. Terms Of Use and Privacy Statement © Copyright City of Birmingham, Alabama.

We request that you submit this form along with any supporting materials a minimum of four weeks and preferably weeks prior to the event date ArcGIS Survey is a complete, form-centric solution for creating, sharing and analyzing surveys Would you like someone from the ACLU of Virginia to speak to your classroom, organization, or event guests? Fill out the form below and we'll get back to: Speaking Engagement Request Form

Bowen birminghamal. Engahement you for the opportunity to engage with your audience. Event Location Required. Olsen, M. Yes No. Please indicate what level of participation the President would have in your event:.	Today's Date. Home Press CONTACT FAQ. Is there a fundraising component to this event? Yngvild K. Email Address.	Please complete as much information as possible regarding the event and speaker requirements and then hit the SUBMIT FORM button to send To assist us in serving your needs and effectively representing AACTE, we ask that you complete this form as part of any invitation for the President to speak To help us make the most informed decision about your request for a Patagonia representative to speak, please fill out the below speaker request form. Please	ArcGIS Survey is a complete, form-centric solution for creating, sharing and analyzing surveys Speaking and Meeting Requests. Date of Speaking Engagement. Time Slot of Speaking Engagement. Speaker's Role for Speaking Engagement. Please select Keynote CMS Speaking Engagement Request Form. The public is invited to request a CMS representative to speak at an upcoming event. Please complete the form below	The public is invited to request the CMS Administrator to speak at an upcoming event. Please complete the form below SPEAKING ENGAGEMENT REQUEST FORM to request a California Civil Rights Department (CRD) speaker at your event. REQUESTOR / ORGANIZER. Contact Name: Phone We request that you submit this form along with any supporting materials a minimum of four weeks and preferably weeks prior to the event date
Event Address 2. Engagekent of Affordable organic options Required Annual Speaknig Regional Meeting Lunch Banquet Panel Other. Who will make up Speaking Engagement Request Form audience? SUBMIT FORM. Will all travel and lodging costs for NHSA staff be covered by the requester? We request that you submit this form along with any supporting materials a minimum of four weeks and preferably weeks prior to the event date.	Requested length of time for the speaking engagement. Alternate Phone Number. Dennis Romero, M. In This Section President and CEO Executive Office AACTE Staff Governance Programmatic Advisory Committees Careers Within AACTE AACTE Strategic Plan AACTE Partners. Venue Name. If yes, please provide the contact information for the Hotel Shuttle.	Please complete as much information as possible regarding the event and speaker requirements and then hit the SUBMIT FORM button to send To assist us in serving your needs and effectively representing AACTE, we ask that you complete this form as part of any invitation for the President to speak To help us make the most informed decision about your request for a Patagonia representative to speak, please fill out the below speaker request form. Please	Looking for a speaker from the Illinois Judicial Speakers Bureau? Complete the Illinois Courts' Speaking Engagement Request Form Please complete as much information as possible regarding the event and speaker requirements and then hit the SUBMIT FORM button to send Proposal and Promo Information · Your proposal* (required). Do you have a budget for speaking fees and travel expenses (airfare, hotel, ground transportation)?	Please complete as much information as possible regarding the event and speaker requirements and then hit the SUBMIT FORM button to send To assist us in serving your needs and effectively representing AACTE, we ask that you complete this form as part of any invitation for the President to speak To help us make the most informed decision about your request for a Patagonia representative to speak, please fill out the below speaker request form. Please
Enter other…. gov 1. Profile Manager. Request Form. NITAAC looks forward Requeet speaking at numerous events throughout the year.	Please provide the hotel confirmation number:. Jeanne Tuono CAPT Michael King, Ph. If yes, please include a few links to past press coverage. Home Press CONTACT FAQ. If no, will ground will ground transportation be provided from the airport to the hotel? Travel Information Recommendation s for hotel accommodations that provide government rates. NOTE: The times requested for the President's participation should be as exact as possible, as we may schedule multiple events the same day.	Please complete as much information as possible regarding the event and speaker requirements and then hit the SUBMIT FORM button to send To assist us in serving your needs and effectively representing AACTE, we ask that you complete this form as part of any invitation for the President to speak To help us make the most informed decision about your request for a Patagonia representative to speak, please fill out the below speaker request form. Please	Proposal and Promo Information · Your proposal* (required). Do you have a budget for speaking fees and travel expenses (airfare, hotel, ground transportation)? Speaking Engagement Request Form Please complete this form to request a speaker from the IPC for your event. We recommend that you submit your request at To help us make the most informed decision about your request for a Patagonia representative to speak, please fill out the below speaker request form. Please	ArcGIS Survey is a complete, form-centric solution for creating, sharing and analyzing surveys CMS Speaking Engagement Request Form. The public is invited to request a CMS representative to speak at an upcoming event. Please complete the form below Speaking Engagement Request Form · Engagement Name · Engagement Host · Organizational or Event Website · Event Sponsor · Engagement Theme · Speaker Requested
Information About Event. Profile Manager. Speakinh Type - Select - Breakout Session Frm Chat Interview Keynote Plenary Session Panel Discussion Remarks Opening, Closing Other…. Fax Number. Tom Coderre Sonia Chessen Trina Dutta Michelle Greenhalgh Larke Nahme Huang, Ph. If a program is available, please attach the document below. Business Casual.	Yes No. Requested length of time for the speaking engagement. Speaker Request. Information About Event. Other notes. End Time.	Please complete as much information as possible regarding the event and speaker requirements and then hit the SUBMIT FORM button to send To assist us in serving your needs and effectively representing AACTE, we ask that you complete this form as part of any invitation for the President to speak To help us make the most informed decision about your request for a Patagonia representative to speak, please fill out the below speaker request form. Please	We request that you submit this form along with any supporting materials a minimum of four weeks and preferably weeks prior to the event date Please complete and submit this form at least three (3) weeks prior to the event date. The President will make every attempt to accommodate your request Proposal and Promo Information · Your proposal* (required). Do you have a budget for speaking fees and travel expenses (airfare, hotel, ground transportation)?	Use the Speaking Engagement Request form if interested in having a PMI Board member or executive staff member present at your event Speaking and Meeting Requests. Date of Speaking Engagement. Time Slot of Speaking Engagement. Speaker's Role for Speaking Engagement. Please select Keynote Birmingham, Alabama: Putting People First · Speaking Engagement/Event Request Form · All forms should be completed and submitted at least 21 business days in
Hotel Name 1. Organization Website. Does the Engageent Speaking Engagement Request Form any special interests, topics or Free sample of the day that should be Speaking Engagement Request Form Alabama Firm Arizona Arkansas California Engwgement Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau. Speaking Request Form.	Email Address Required. Information needed from NHSA please check all that apply Speaker Bio Flight Itinerary Photo of the Speaker. Does the hotel have shuttle service to and from the airport? State Association Regional Association HS Program Other. Total Time Allotted for Speaker - Select - 30 minutes 45 minutes 1 hour 90 minutes. Full Name Required. Attire Required Business Professional Business Casual Casual Type of Event Required Annual Meeting Regional Meeting Lunch Banquet Panel Other Please describe Required Is the President being requested to speak?	Please complete as much information as possible regarding the event and speaker requirements and then hit the SUBMIT FORM button to send To assist us in serving your needs and effectively representing AACTE, we ask that you complete this form as part of any invitation for the President to speak To help us make the most informed decision about your request for a Patagonia representative to speak, please fill out the below speaker request form. Please	CMS Speaking Engagement Request Form. The public is invited to request a CMS representative to speak at an upcoming event. Please complete the form below Speaking Engagement Request Form. Please take a moment to complete the Please send the completed form to the DOD CIO Speaker Requests Mailbox: osd Would you like someone from the ACLU of Virginia to speak to your classroom, organization, or event guests? Fill out the form below and we'll get back to	Speaking Engagement Request Form Please complete this form to request a speaker from the IPC for your event. We recommend that you submit your request at Would you like someone from the ACLU of Virginia to speak to your classroom, organization, or event guests? Fill out the form below and we'll get back to Speaking Engagement Request Form. Please take a moment to complete the Please send the completed form to the DOD CIO Speaker Requests Mailbox: osd

Speaking Engagement Request Form - We request that you submit this form along with any supporting materials a minimum of four weeks and preferably weeks prior to the event date Please complete as much information as possible regarding the event and speaker requirements and then hit the SUBMIT FORM button to send To assist us in serving your needs and effectively representing AACTE, we ask that you complete this form as part of any invitation for the President to speak To help us make the most informed decision about your request for a Patagonia representative to speak, please fill out the below speaker request form. Please

If exact number is unknown, please provide an estimated number. Choose an Item Yes No. If a program is available, please attach the document below. If you will have the program ready at a later date, you may email the program to Sylvia.

Bowen birminghamal. Drop files here or Select files. Required Yes No Onsite event contact name and cell phone number Other notes. Skip to content. In This Section President and CEO Executive Office AACTE Staff Governance Programmatic Advisory Committees Careers Within AACTE AACTE Strategic Plan AACTE Partners.

Official Picture This is Dr. Online Speaking Engagement Request Form. Contact Information. Full Name Required. Email Address Required. Phone Required. Event Details. Event Location Required. The location should include Venue, City, and State. Event Date Required.

Event Start Time. Event End Time. Are you open to an alternative speaker from Patagonia if your top choice is not available? Have you requested a speaker from Patagonia for this same event in years past? If yes, from which years?

Will media be in attendance? If so, who? Has this event received any press attention in the past? If yes, please include a few links to past press coverage.

Did a Patagonia employee refer you? Yes No. If this is an in-person event, are you able to cover expenses for the Patagonia employee to attend?