CEO Speaking Request Form
Thank you for inviting President and CEO Charlie Davis to speak at your event or meeting; please complete and submit this request at least four weeks prior to the engagement. Requests are reviewed weekly and responded to as CEO availability is determined. The more information you provide, the better we'll be able to determine CEO availability. Please note that not all requests can be accommodated.
Event/Meeting Contact
Contact:
*
First and last name
Title:
Organization:
*
Email:
*
example@example.com
Phone number:
*
-
Area code
Phone number
Event/Meeting Details
Name of event:
Event date:
*
-
Month
-
Day
Year
Date
Event start and end time:
*
Event location:
*
Full address, please
Topic/theme/purpose of event:
Expected audience size:
Audience:
*
Community members
Donors
Y members
Staff
Other
Would you like the CEO's simple bio or a photograph for print materials?
Simple bio
Photograph
Other
Dress code:
Business casual
Casual
Formal
Format:
Keynote
Panel
Round table
Other
Will a meal be served?
Yes
No
Presentation Details
CEO's role:
*
Meet and greet
Speak/present
Reception
Length of speaking/presentation time:
*
Welcoming remarks (3-5 minutes)
Short remarks (6-10 minutes)
Full speech (11-20 minutes)
Major address (21+ minutes)
Additional time for Q&A
Other
CEO speaking/presentation start and end time:
*
Time requested for CEO participation should be as accurate as possible as he often has multiple events in one day. If your event/meeting schedule changes after submitting this request, please notify the CEO's office as soon as possible.
Would you like CEO to attend entire event/meeting or will he be excused?
*
Excused after speaking/presenting
Please attend entire event/meeting
Are there people in the audience who should be recognized and/or thanked?
Yes
No
If so, please provide name(s), title(s), and reason(s):
Are there any other speakers at this event/meeting?
Yes
No
If so, please provide name(s) and title(s):
If CEO is unable to attend your event/meeting, would you like us to recommend an alternate speaker?
*
Yes
No
Equipment
What type of equipment is being used at this event/meeting?
Podium
Projector
Sound system
Handheld microphone
Lavaliere microphone
HDMI
VGA
Other
Other details regarding available equipment:
If a microphone is recommended due to size of venue, CEO is best served using a lavaliere.
Media
Do you expect any media to attend?
Yes
No
If yes, please provide more detail:
Will this event be recorded and made available to others?
Yes
No
If yes, how will the footage be shared?
Other
Comments or additional information:
Submit Request
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