Speaker Request Form
Please submit to TAF at least 60 days before the event.
Date Submitted
-
Month
-
Day
Year
Today's Date
Coordinator Name
*
Contact person for us
Organization
*
Group or organization requesting speaker
Coordinator Email
*
A copy of this form will be emailed to you.
Coordinator Phone
*
Phone number where we can reach you
Do you have a preferred speaker?
Enter their name here, or "any"
Desired Event Date/Time
*
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Event Length
*
How much time is available for the speaker?
Event Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Attendee Demographics
*
Event Goal
*
How will we know if we are successful?
Estimated # of Attendees
*
Is a screen available?
*
Yes
No
Is WiFi available?
*
Yes
No
Will this be recorded?
*
Yes
No
Will this be videoed?
*
Yes
No
Will you provide an emcee?
*
Yes
No
Other important information for us?
Submit Form
Should be Empty: