DEM Senior Leader Speaker Request
Request a Senior Leader from the Department of Emergency Management to speak at a conference, symposium, or panel. The Department of Emergency Management requires 30 days notice to accommodate a speaker/presentation request. All invitations are up to the discretion of the speaker/presenters.
Organization Name
Point of Contact Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Type of Organization
For Profit
Not For Profit
Volunteer Organization
Trade Association
Local Government
State Government
Federal Government
International
Other
Event Name
Event Purpose
Event Webpage
Event Agenda
1st Choice Speaker Requested
2nd Choice/Back-Up Speaker Requested
Deadline for Acceptance
Event Date and Time
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Speech Duration
Speech Topic and Specific Topic/Points or Questions to Answer
Presentation Format
Keynote
Roundtable
Panel Discussion
One-On-One Interview
Questions & Answers
Audience (please describe who will be in attendance and the sector or industry represented)
Please identify any guests of honor who are attending or being recognized at this event
List name, title, and agency/organization
Cost of Attendance
Event Sponsors
Open or Closed to Press
Open to press
Closed to press
Submit
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