Return to:
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:
Place
City
State
Luncheon
Dinner
Other (Specify)
Subject 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:
1.
2.
3.
4.
5.
6.
Public address system
Lectern
Videotape player and monitor
A lavalier or lapel microphone
Slide projector
Light pointer
Are suitable hotel or motel accommodations available?
1. Name
2. Address
Expected attendance
Name and signature of person completing this form:
Organization title or affiliation:
Telephone number:
Figure 6-21.-Speaker request form.
6-42
