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ATA Speaker Request Form

Date of Request

Name of Organization *

Indicate type of speaker requested

ATA Staff Chairman

ATA Chairmen

Please indicate name of ATA staff speaker, if other than current chairman is requested.

Dates of meeting

Location of meeting (Hotel/Resort and City/State)

Date and time of presentation *

Type of presentation*
*

Presentation Duration *

Will there be Q&A?

Yes No

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?

Please indicate which expenses your organization will cover? (ex: registration, transportation, hotel, and/or meals) *

Which airport is the closest/best airport for arrival/departure? *

What is the dress code for the meeting? *

Other

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?

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?

Enter additional information below (e.g., Additional speakers requested):