MBA Speaker Request Form

* Denotes required fields.

Requested Speaker: *

Date & Time of Speaking Engagement: *

Requesting Organization: * Event Name: * Is the organization an MBA member? : *

Have you previously had an MBA speaker? If yes, who?: Contact Name: * Contact Office Phone: Contact Mobile Phone: * Contact Email: *

Event Details

In person or virtual?: * Who is Attending? (Select All that Apply): How many attendees at the event? : How many attendees at this session? : Event website (please enter full URL including the HTTPS://): Location (Address & Room) of Event: Attire for Event: Is travel expense offered, such as hotel, airfare, taxis, etc..?: Format and Duration (Please list any Keynote, Panel, Q&A formats, and please be as specific as possible as to length of speaking time, and overall duration of speaking engagement): Topic: Who will introduce the speaker(s) or moderate the panel? Please list Name and Title: : Will the speaker be swearing in new MBA Officers? (State MBAs only):

Technical Platform Requirements

Technical platform/requirements?:

Are you requesting a live or pre-recorded speech? :

If Live, what are the technical requirements?: If Virtual, what platform will you be using? i.e. Zoom, GoToMeeting, etc.: Will media be present or invited to join?: Please check this box: *