Aspiring Educator Chair Speaker Request Form

Fill out the form to request the AE Chair at your event.

General Information

Requested Date*

Sponsoring Organization*

Requested Speaking Time (please add time zone)*

Event Title/Event Theme

Will this event be held virtually?*

Select or enter value

Web-Conference Technology

Select or enter value

Web Link

Meeting ID

Format

Select or enter value

Other Activities*

What other activities planned with this event (if any) will the chair be able to participate in? Please describe briefly:

Will there be a Q&A?

Select or enter value

Additional Time with Members

In addition to training and speaking the Aspiring Educators Chairperson would like to conduct a listening tour at every speaking engagement. Will your event include an opportunity for a small group (8-10 members) to meet with the Chair for discussion?

Select or enter value

Venue

Suggested Hotel and Contact Information

Suggested Airport/Train Station

Primary Event Contact*

Primary Event Contact Role/Title*

Primary Phone*

Email*

File Upload

Please attach any flyer, etc that has been shared with participants.

Drag and drop files here or

Send me a copy of my responses

Privacy Notice|Report Abuse