MDP Speaking Request
Email address *
Would you like the Chair to speak at this event? *
Name of organization hosting event *
Your answer
Name of primary person responsible for organizing event *
Your answer
Cell phone number of primary contact *
Your answer
Please provide a link to organization's website
Your answer
Please identify the date of the event *
MM
/
DD
/
YYYY
At what time will the event begin? *
Time
:
Please identify the name of where the event will be held *
Your answer
Please identify the address of event location *
Your answer
What type of event is this (e.g. awards banquet, rally, conference etc.)? *
Your answer
What is the overall theme of this event? *
Your answer
Please identify dress code for this event
Your answer
What is the expected size of the audience?
Your answer
At what time will the speaker be expected to participate?
Time
:
Please identify parking information
Your answer
Will the press be invited to attend and cover this event? If so, please identify invited media *
Your answer
Please submit at least 3 weeks prior to event date.
By submitting this form, you acknowledge that a request does not constitute a guarantee that the speaker will be available for this event. If you have questions, please contact (410) 269-8818.
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