MPI Staff and Board Request Form

MPI Staff and Board Request Form

This form should be used to request assistance or support for an MPI Staff or Board Member.

Name of MPI Staff or Board Member being requested

Tell Us About You

Your Name

Your Email

Briefly describe the purpose of your request

"I would like this person to present for 20 minutes on ____" or "I would like to have this person record a video message"

I am requesting on behalf of:

Select or enter value

Tell Us About Your Request

Event Title

Event Date

Event Location

Estimated Audience Size:

Event Description

Event Objective

Is this an in-person or virtual request

Select or enter value

Speaking to / Chapter audience

Additional Details about this request

Send me a copy of my responses

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