BPIA Speaking & Public Engagement Request Form
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Organization Name *
Event Name *
Event Date *
Event Time *
Event Location *
Event Description *
Event Website
Organization Website
Who will make up the audience? *
Audience Size *
Who from BPIA are you requesting to speak? *
Will this event be virtual or in-person? *
Is this for a keynote, panel, or fireside chat? *
What topic or subject are you interested in hearing about? *
Are you open to an alternative speaker from BPIA if your top choice is not available?
Have you requested a speaker from BPIA to speak for an event in years past? *
If yes, from which years?
Will media be in attendance?
If so, who?
Has this event received any press attention in the past?
If yes, please include a few links to past press coverage.
Is this event open to the public? *
Please list other potential or confirmed participants for this year's event.
Were you referred to me? If so, by whom?
If this is an in-person event, are you able to cover expenses for the speaker to attend? *
Is there a ticket cost for people to attend this event? If so, are you willing to provide tickets to BPIA members at no cost?
Contact Information
First Name *
Name Last *
Email Address *
Confirm Email Address *
Phone Number *
When is your deadline to hear back regarding this request?
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