SpeakingEngagementRequestForm

Speaking Engagement Request Form

Engagement Name What is the name of your event?

Engagement Host Organization hosting the event

Organizational or Event Website Please provide the website URL for this event

Event Sponsor Who is sponsoring this event?

Engagement Theme What is this event about?

Speaker Requested Which speaker are you requesting speak at your event?

If Requested Speaker is Unavailable is a Deferral Acceptable?

If yes, please enter desired alternate speaker.

Requested Topic

What is the event date and speaking time slot?

dd/mm/yyyy, mm:hh

Time Allotted

Is a Question and Answer Time Scheduled?

If yes, how much time will be allotted?

If the event will be pre-recorded, what is the pre-record date & time?

Location

Unit

Street

City

Region

Country

Zip

Will the media be present?

Will Event Be Live Streamed?

Format

Presence

If the event is virtual, what platform will be used?

Notable Attendess or Other Speakers Are there any Notable Attendees or Other Speakers?

Number of Attendees How many attendees do you expect?

What is the audience background or experience level?

Has the DoD CIO (or a Representative) Spoken here before?

If yes, who?

Event POC

Prefix

First

Last

Suffix

POC Phone Number

POC Email Address

Confirm

Remarks