San Francisco Department of Emergency Management SENIOR LEADERSHIP SPEAKER REQUEST
The Department makes every attempt to accommodate requests received with at least 30 days notice. Upon submission of form, please forward a copy of the event agenda to
Official title of event
Organization or group making request
Internal Coordinator/ Point of Contact
Name and title of person making request
Speaker Requested (If Applicable)
Name & title of speaker requested or area of expertise
Will the event accept an alternative speaker?
Brief Event Description
Goals and objectives of event
Location name and address
Event Web Site
For Profit/Not for Profit
Please indicate whether the event if for profit or not
List sponsors and co-sponsors if applicable
Cost of Attendance
Please include member and non-member price if applicable
Deadline for Acceptance
Date by which you must have an answer
Define topic/points to cover
Speech Time & Duration
Keynote speech, roundtable, panel, etc.
Question & Answer Period
If there is Q&A, what is the duration?
Number of Expected Attendees
Describe audience, its background and if membership is required to attend
Honorable Guests Attending
List names and titles of members of Congress, CEO's, or VIPs participating in or attending the event
Open Press/Closed Press
Will any media be present?
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