Request a Speaker

Date*
MM slash DD slash YYYY
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Phone
Name of Event*
Requested Role/Roles of NOBC representative:*

(speaker, breakouts, reception, other)
Date of Event*
MM slash DD slash YYYY
Time of Event*
Event Location (venue/hotel)*
Event Location*
City State
Length of Presentation*

: Hours

Minutes
Audience*
Please describe the audience including expected number and description of your target audience
Expected number of attendees*
Outcomes*
What are your expectations for participants to learn/take away from this session?
Success*
How will you measure the success of our participation?
Travel Arrangements*
NOBC requires airfare, hotel and travel arrangements to be covered by requesting organizations, are there any specific guidelines for travel budget and arrangements?
Honorarium
Additional comments/considerations