Request a Speaker

Thank you for your interest in having a Visit Mobile speaker at your event. Please fill out the following form, for local events please submit at least 2 weeks prior to the event, for out of town engagements, please submit at least 6 weeks prior to the event. Please allow 3 to 5 days for a decision to be made. 

AWAITING FORM

Event Organizer

Event Details

(conference, dinner, small group, etc.)

(if applicable)

Presentation/Speech Details Requested

(keynote address, roundtable, panel, etc.)

(30 minutes, 1 hour, etc.)

(Will the speech be followed by a Q&A session?)

Audience Details

(Approximate size of audience. Also briefly describe its make-up and if membership is required to attend.)

(Will media be invited? If so, will the event be open or closed press? Also describe and submit media list.)

Additional Information

(please include member and nonmember price, if applicable)

(none, dining, lodging, travel, etc.)

(Please indicate whether or not the event sponsor will need the speaker to sign a disclaimer/release form.)

Red fields are required.



Please enter the 4 character string shown in the box above.