MBA Speaker Request Form

* Denotes required fields.

Requested Speaker: *

Date & Time of Speaking Engagement: *

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

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

Event Demographics

In person or virtual?:

In Person Event Details

Who is Attending? (Select All that Apply): How many attendees at the event? : How many attendees at this session? : Website of Event: Location (Address & Room) of Event: Attire for Event: Is there travel expense coverage (hotel, airfare, taxis, etc.): Format and Duration: Keynote, Panel, Q&A (please be as specific as possible): Topic: Who will introduce speaker(s)? (Name and Title): Will the speaker be swearing in new MBA Officers? (State MBAs only):

Virtual Event Details

Technical platform/requirements?:

Live, recorded or both?:

Please check this box: *