SACNAS Executive Director Speaking Engagement Form

SACNAS Executive Director Speaking Engagement Form

General Information

Requestor (Full Name)*

Organization*

Email Address*

Phone Number*

Website*

Event Name*

Event Date*

Event Time*

Event Format*

Select or enter value

Event Location*

Speaking Category*

Select or enter value

Duration of Speaking Engagement (in minutes)*

Primary Contact (if different than Requestor)

Please include full name, email address and phone number.

Event Description:*

Please include name of moderator, panelists/speakers, and any information regarding session participants.

Audience Composition/Size*

Will A Script/Questions be Provided?*

What Preparation is Required?*

Please note if any preliminary meetings or calls are required.

What perspective would Mr. Amador add?*

What topics or areas of particular interest would you like to hear about from him?

Will travel expenses be covered?*

If travel is required for participation, will related expenses be covered by your organization? If yes, please provide details.

Honorarium*

Is your organization willing to make a donation to SACNAS in lieu of an honorarium?

If Mr. Amador is unavailable*

If Mr. Amador is unavailable, are you open to connecting with another SACNAS representative?

Select or enter value

If yes,

please describe the type of expertise you seek for your event:

Desired date of response:

Send me a copy of my responses