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NACD Speaker Request Form
Looking to invite a representative from NACD's leadership or staff to your state or district meeting? Please fill out the following form and indicate if you have a preferred officer or staff member in mind. Please note: NACD may not be able to accommodate all requests for in-person presentations. Questions? Contact NACD Executive Assistant/Office Manger Colt Fossum at
colt-fossum@nacdnet.org
.
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* Indicates required question
Email
*
Your email
Contact Name
*
Your answer
Contact Phone Number
*
Your answer
Event Name
*
Your answer
Event Organizer (District/State Association/Organization/Company Name)
*
Your answer
Event Location (please include city and state)
*
Your answer
Event Date(s) and Time
*
Your answer
Type of Speaking Engagement
*
General session speaker
Breakout session speaker
Panel speaker
Welcome/introductory remarks speaker
Banquet speaker
Media interview
Other
Required
Specific Topics You'd Like Addressed?
Your answer
Preferred Officer?
*
President Kim LaFleur
First Vice President Gary Blair
Second Vice President Bill Simshauser
Secretary-Treasurer Mark Masters
Immediate Past President Michael Crowder
CEO Jeremy Peters
NCF Chair Brent Van Dyke
No preference
I am not requesting an officer's presence at this meeting
Required
Preferred NACD Staff Member?
*
My NACD Region Representative
Government Affairs Team Member
Communications Team Member
Membership Team Member
Development Team Member (includes Stewardship and Education)
No preference
I am not requesting a staff member's presence at this meeting
Other:
Required
Are any costs covered?
*
Registration
Lodging
Transportation
No costs are covered
Other:
Required
What costs do you anticipate for NACD? This can include any costs from the question above that are not covered, meals, tours, etc.
*
Your answer
Additional information
Your answer
Send me a copy of my responses.
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