MBA Speaker Request Form

Requested Speaker:

Write-in Speaker Name (If you have selected the option above):

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):

Executives

Originators

Services

Loan Officers

Brokers

How many attendees at the event? :

How many attendees at the 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?:

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