Event/Speaker Form

TYPE OF REQUEST

• Speaker request- Flood Control employee presents to a group

• Event/Booth request – Flood Control employee attends event and staff's booth

• Event Request – Flood Control employee attends as a representative (No speaker)

Are you requesting a specific speaker?

Event Date

Event Name & Description

Organization Name and Description

Organization Website

What types of media are invited to the event??

Event Topic

Speaking Topic Details (Please list specific topics of interest to group)

Event Venue

City

Region/State/Province

Postal / Zip code

Please provide the names and titles of the other speakers/panelists

Are you expecting any distinguished guests at this event?

Audience Size

Start Time

End Time

Speaking Duration

First Name

Last Name

Phone