ATA Speaker Request Form
ATA Speaker Request
Travel Arrangements
Audio/Visual
Additional Information
ATA Speaker Request Form
Date of Request
Name of Organization
Indicate type of speaker requested
ATA Staff
Chairman
ATA Chairmen
Select One
Kevin Burch
Dave Manning
Barry Pottle
Sherri Brumbaugh
Randy Guillot
Please indicate name of ATA staff speaker, if other than current chairman is requested.
Location of meeting (Hotel/Resort and City/State)
Dates of meeting
Date and time of presentation
Type of presentation
Select One
Panel
Keynote
Podium
Other (specify below)
Other
Duration of presentation (excluding Q&A)
Will there be Q&A? If so, for how long?
Name of session
Provide issues of interest you would like to be discussed.
Please provide a contact number or email address of your organization’s contact person for this request
Please provide submission date of Bio and/or photo if required.
Will there be other ATA Staff members attending or speaking at this meeting?
Approximately how many attendees do you traditionally have at your meeting?
Travel Arrangements
Indicate which expenses your organization will cover? (ex: transportation, hotel and/or meals)
If a meeting registration is required, please provide a link to your website or registration form
Which airport is the closest/Best airport for arrival/departure?
What is the dress code for the meeting?
Will there be themed or special attire events?
Audio Visual
Would it be possible to have the room set for a PowerPoint presentation?
Would it be possible to have audio availability?
Presentation is provided via Dropbox, please provide email address of person who should receive link
Will you have staff available to assist with PowerPoint or AV if needed?
Additional Information
Enter additional information below (e.g., Additional speakers requested):
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