ATA Speaker Request Form
Please complete this form to request an ATA speaker and provide event details. Required fields are marked with an asterisk (*).
Date of Request
*
-
Month
-
Day
Year
Date
Name of Organization
*
Email
example@example.com
Indicate the type of speaker requested
*
ATA Staff
Chairman
Select Chairman from list below:
*
Please Select
Greg Hodgen, Chairman
Derek Leathers, First Vice Chair
Randy Clifford, Second Vice Chair
Gregg Troian, Vice Chair
Dennis Dellinger, Immediate Past Chair
Dates of meeting
*
Please indicate name of ATA staff speaker, if other than current chairman is requested.
Location of meeting (Hotel/Resort and City/State)
*
Date and time of presentation
*
Type of presentation
*
Please Select
Select One
Fireside Chat (Chairman's Preference)
Panel
Keynote
Podium
Other (Specify below)
Other
Presentation Duration
*
Please Select
Select One
20 Minutes
30 Minutes
45 Minutes
Will there be Q&A?
Yes
No
Name of session
Provide issues of interest you would like to be discussed.
Please provide a contact number or email address of your organization’s contact person for this request
*
Please provide submission date of Bio and/or photo if required.
*
Will there be other ATA Staff members attending or speaking at this meeting?
Approximately how many attendees do you traditionally have at your meeting?
Back
Next
Travel Arrangements
Please provide information about travel logistics for the event.
Indicate which expenses your organization will cover? (ex: registration, transportation, hotel, and/or meals). Due to the number of requests received and the rising cost of travel, helping share the cost of leaderships participation in your event is taken into consideration when determining availability.
*
If a meeting registration is required, please provide a link to your website or registration form.
Which airport is the closest/best airport for arrival/departure?
*
What is the dress code for the meeting?
*
Will there be themed or special attire events?
Back
Next
Audio Visual
Please provide details about audio/visual needs for your event.
Would it be possible to have the room set for a PowerPoint presentation?
Would it be possible to have audio availability?
Presentation is provided via Dropbox, please provide email address of person who should receive link.
Will you have staff available to assist with PowerPoint or AV if needed?
Back
Next
Additional Information
Please provide any additional information relevant to your request.
Enter additional information below (e.g., Additional speakers requested):
Submit ATA Speaker Request
Should be Empty: