NETPMSA Public Affairs Office
ATTN: Speakers Bureau
Pensacola, Florida 32509-5000
Requesting organization and point of contact:
Date of request:
Date and time presentation is desired:
Length of presentation:
Type of audience (technical, general public, male, female, mixed, private group):
Are the facilities to be used during this meeting open to all, regardless of race?
Will any racial group be excluded from or segregated within your meeting?
Is any racial group excluded from membership in your organization?
Will transportation be available at the arrival point (airport, rail terminal, etc.)?
Will the following equipment be available for the speaker:
Public address system
Videotape player and monitor
A lavalier or lapel microphone
Are suitable hotel or motel accommodations available?
Name and signature of person completing this form:
Organization title or affiliation:
Figure 6-21.-Speaker request form.