Speaker Request Form

Thank you for your interest in having the Federal Motor Carrier Safety Administration speak and present at your event. So that we can give your invitation full consideration and make a prompt decision, please provide as much detail as possible 30 days in advance of the event date. Under ordinary circumstances, expect to hear back from us within 7 to 10 business days of receiving your request.

Event Title

Event Website and/or Company Website

Event Host Organization

Event Date

Event Time

Date and Time for Speaker/Presenter

Location

Venue Description/Layout of the Room

Contact Information

Name

Title

Business Telephone

Business Email

Organization Name

Type of organization

If other, please specify

Events Participants

Target Audience

Anticipated Audience Size

Presentation/Topic

Requested Topic

Requested FMCSA Speaker/Presenter

Type of Presentation

If other, please specify

Length of Presentation

Will speaker be expected to answer audience questions following their remarks

If yes, will the questions be written and pre-submitted or ask/answered on the spot?

Are you willing to accept a surrogate if your first choice is not available?

Have FMCSA staff/leadership spoken at previous events? If so, who, where, and when?

What is the response due date?

Media Plans?

Are there exhibitor opportunities?

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