CEO, Kelly Schulz, Speaker Request Form

CEO, Kelly Schulz, Speaker Request Form
Thank you for your interest in the Maryland Tech Council. Please fill out and submit the information required. We will follow up within 5 business days. Please note that submitting this form does not guarantee the CEO’s availability. For any questions, please contact Pam Lubel at pam@mdtechcouncil.com or 240-243-4049.
I. Contact Information:
Full Name*

First NameLast Name
Title*
Organization*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
II. Event Details:
Event Name
Date*

MonthDayYear
Date
Time*

Hour Minutes

AM/PM Option
Event Location*

Physical AddressVirtual
Event Physical Address*

Street Address

Street Address Line 2

CityState

Zip Code
Expected Audience Size*
III. Event Description:
Brief Description of the Event and its Purpose:*
Topic or Theme of the Event:*
Expected Duration of MTC CEO’s Presentation:*
Other Speakers or Participants (if any):*
IV. Additional Information:
Travel Arrangements:*
Accommodation Needs (if applicable):*
Equipment/Technical Requirements (if virtual):*
Any Other Additional Information or Special Requests:*
Should be Empty: