ATA Speaker Request Form

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*

MonthDayYear
Date
Name of Organization*
Email
example@example.com
Indicate the type of speaker requested*

ATA StaffChairman
Select Chairman from list below:*
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*
Other
Presentation Duration*
Will there be Q&A?

YesNo
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?

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)*
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?

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?

Additional Information

Please provide any additional information relevant to your request.
Enter additional information below (e.g., Additional speakers requested):
Should be Empty: