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California Department of Aging (CDA) Speaker Request Form
Thank you for your interest in having a CDA speaker for your event. While we cannot guarantee the availability of the speaker you are requesting, we do ask that this form be submitted at least six (6) weeks in advance. of your event. After completion of this form, we will contact you in eight to ten business days
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What is the title of the event for which you are requesting a speaker? If there is online information or a website with an event description, please include a link. *
What is the date of the event? *
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What is the time of the event? *
Time
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Where is the event taking place? *
If the event is taking place in-person, what is the location and physical address of the event?
Is a powerpoint/slide presentation needed? *
Required
Do you have a request for a specific CDA speaker or speakers? *
If requesting a specific speaker (s), who are you requesting?
For approximately how long do you wish them to speak? *
What kind of speaking opportunity is this? *
If this is part of a panel presentation, please list other proposed panelists you anticipate might also be present.
What kind of specific talking points or subject matter expertise are you looking for? *
Who is the primary audience for this event? *
How many attendees are you anticipating? *
By what date do you need confirmation of speaker attendance, photo and bio? *
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Who is the best point-of-contact we can follow up with on questions, speaker materials and confirmations? (Name, Title, Email & Phone Number please) *
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