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MBDA Speaker Request Form

Microphone Thank you very much for your invitation for a member of the MBDA leadership team to speak at your event. As the only federal agency charged with promoting the growth and competitiveness of minority-owned firms, we receive numerous requests throughout the year. To facilitate our ability to give your invitation full consideration and make a prompt decision, please provide us with as much detail as possible at least 3 months in advance of the event date.

Under ordinary circumstances, you should expect to hear back from us within three weeks of receiving your invitation so you can proceed with your plans. Invitations to events that fall short of the 3 month advance notice may still be considered.

Fields marked with an asterisk (*) are required.

EVENT LOGISTICS

Event Host: *

Event Title: *

Event Date: *

Event Time: *

Date and Time for Speaker:

If different from above.

Location: *

Event Overview: *

Attachment:

If available, please attach the official letter and or the agenda of the event.

CONTACT INFORMATION

Name: *

Title:

Telephone: *

E-mail: *

Company Name:

Type of Organization: *

If other, please note:

Event Web Site:

EVENT PARTICIPANTS

Target Audience: *

Anticipated Audience Size: *

PRESENTATION/TOPIC

Requested Topic: *

Type of Presentation: *

Length of Presentation: *

Position Requested: *

Are you willing to accept a surrogate if your first choice is not available?: *

Yes

What is the response due date?:

If a response is needed by a certain date, please provide the due date in the above field.

Media Plans?: *

Are there exhibitor opportunities?: *

Yes

If yes, please attach Exhibit Information:

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