Presentation Request

Name *

First Name

Last Name

Method of Delivery *

please select all that apply

In-Person

Virtual

Prospective Date of Event -- First Choice *

MM

DD

YYYY

Second Choice Date *

MM

DD

YYYY

Event Start Time *

Hour

Minute

Second

AM PM

Start Time of Speaker *

Hour

Minute

Second

AM PM

End Time of Speaker *

Hour

Minute

Second

AM PM

Time Zone *

Eastern time

Central time

Pacific time

Mountain time

Hawaii-Aleutian time

Alaska time

Venue Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Organization Will Cover Expenses *

Yes

No

Expenses Covered By Organization

Air Travel

Car Service

Hotel

Honorarium *

Yes

No

Deadline For Response *

MM

DD

YYYY