Speaker Request Form

Speaker Request Form

Sufian Hanafi
Nature of Event
Your Name

DesignationGiven Name
Your Contact Email
Your Contact Number

Country CodePhone Number
Name of Requesting Organization & Department
Proposed Title of Event (if any)
Indicate NA if Not Applicable
What is the nature of your event?
Objectives of Your Event
Kindly indicate in point form
Role of the Speaker (Tick Accordingly)

Other
Language of Delivery (Tick accordingly)
Who are the other proposed invited speakers or GOHs, if any?
Indicate NA if Not Applicable
Kindly indicate if you require any verification documents from the speaker
Indicate NA if Not Applicable
If you have already prepared a proposal, please upload and share with the speaker.

Cancelof
Event Details
Is the LOCATION of Event confirmed?
Proposed LOCATION of the Event
If the LOCATION of Event has not been confirmed, when will the LOCATION be confirmed?

DayMonthYear
Indicate today's date if it has been confirmed
Is the DATE of Event confirmed?
Proposed DATE of Event

DayMonthYear
Date
If there is a series of DATES and EVENTS, please indicate the other dates below
Indicate NA if your event is on a single date
If the DATE of Event has not been confirmed, when will the DATE be confirmed?

DayMonthYear
Indicate today's date if it has been confirmed
What is the total number of hours that the speaker is required to be present at the event?
Arrival Time (Speaker to arrive by ...)

Hour Minutes

AM/PM Option
Start Time (Speaker to begin presentation at ...)

Hour Minutes

AM/PM Option
End Time (Speaker to end presentation by ...)

Hour Minutes

AM/PM Option
Departure Time (Speaker to stay on after presentation until ...)

Hour Minutes

AM/PM Option
Q&A Session
How long is the duration of the Q&A session, if any?
Indicate NA if Not Applicable
Is the event ITINERARY confirmed?
If ITINERARY has not been confirmed, when will the ITINERARY be confirmed?

DayMonthYear
Indicate today's date if it has been confirmed
Audience Details
Target Number of Attendees
What is the estimated profile of the audience?
Please describe the event setting, type of seating, and how the audience seating plan will be organized.
Presentation Materials
Do you require the speaker to present slides?
If yes, please tick accordingly

Other
If you require the slide deck before the event, indicate the date that you require the slides

DayMonthYear
Please leave blank if slides are not required before the event
Will the event be recorded?
Please elaborate any other specifications in terms of materials required
Publicity Details
What media platforms will be used to publicize this event, if any?
Do you require a photo of the speaker for publicity materials?
What designation and name of speaker do you intend to use for publicity materials?
Do you require a profile of the speaker for publicity materials?
What is the length of profile write-up that you require, if any?
Financial Matters
Will an Honorarium/Speaker's Fee be provided?
If yes, are you able to provide a pre-event deposit?
What is the proposed amount for Honorarium/Speaker's Fee, if any?
Indicate '0' if no Honorarium/Fee is proposed
What is your payment method?
Indicate NA if no Honorarium/Fee is provided
Do you require a Quotation for the Honorarium/Speaker's Fee?
Do you require an Invoice for the Honorarium/Speaker's Fee?
Name of person and department/organization for Quotation/Invoice, if any?
Do you require any vendor forms to be completed by the speaker?
Are you able to provide a payment advice/document upon payment?
Will you require a receipt upon payment of Honorarium/Fee to the speaker?
Additional Information for Speaker to Note
By when do you require a confirmation from the speaker?

DayMonthYear
Date
Please verify that you are human
Should be Empty:

Speaker Request Form

Nature of Event

Event Details

Audience Details

Presentation Materials

Publicity Details

Financial Matters