Speaker Request Form

Must be submitted at least six months in advance of event

1.
 Parent Club Officer Name:
2.
 Event/Meeting Title:
3.
 Contact Name(s):
4.
 Phone:
5.
 Date of event:
6.
 Time of event:
7.
 Type of event:
8.
 Location (include Street Address, City, State and location contact/phone number). Also list local Airports!
9.
 Location: Indoor Outdoor
10.
 Dress/Attire: Formal Informal
          The above fields are required.
11.
 Estimated time needed for Speaker:
12.
 Estimated number of people attending event:
13.
 List other USNA Contingencies to be invited (i.e. B&G Officers, Alumni, etc.).
14.
 Are you working with the local USNA AA Chapter for this vent? Yes No
15.
 VERY IMPORTANT!
Speaker and Topic Preference (indicate three Academy, Alumni Association or Foundation speaker choices) also include topics of interest:
16.
 Will transportation to and from the airport be provided? Yes No
17.
 Will food be provided? Yes No
18.
 If Necessary, will lodging be provided? Yes No
19.
 If yes, please state details:
20.
 It the Parent Club able to pay travel costs if speaker does not have a travel budget? Yes No
21.
 Additional Comments/Needs:
22.
 Your Name These fields are required so that we can get back to you with any questions concerning form information.
Please enter carefully.
23.
 Your Email Address