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Speaker Request Form
Speaker Request Form
Priority
Urgent
Not Urgent
Schedule Hold
Requested Speaker
CEO Elmer Moore, Jr.
Kim Plache, Deputy Director
Jessica Boling, Asst. Deputy Director
Other WHEDA staff
Other Speaker
Would you be willing to accept another speaker if the one requested cannot participate?
Yes
No
Speaker’s Role for the Event
Keynote
Moderator
Panelist
Welcome/Closing Remarks
Award Presenter
Media/Press Interview
Meeting
Webinar
Reception
Attend Only
Requesting Organization
Phone Number
Contact Name
Contact Email Address
Contact Title
Name Of Event
Event Date
Speaking Start Time
Speaking End Time
Deadline to receive speaker confirmation
Attire
Formal
Black Tie
Business Casual
Casual
Event Location
Event Description
Audience Composition
Audience Size
25 or less
25-50
50-100
More than 100
Focus of Talk
Length of Talk
Attend Only
5 minutes
10 minutes
15 minutes
20 minutes
30 minutes
45 minutes
60 minutes
What type of speaking materials are needed?
When are the materials due?
Will the presentation be recorded?
Yes
No
Is media invited?
Yes
No
Will there be press coverage?
Open to press
Closed to press
Inviting specific press
Associated Social Media
Any additional details we should know?
Submit
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