Recorder

Speaking Engagement Request

Speaking Engagement Request Form

Organization / School / Group Name * If you are scheduling for yourself or your family, please indicate this in the above field.

Organization Website *

Contact First Name *

Contact Last Name *

Contact Email *

Contact Phone Number *

Number of people attending *

Event Date *

Event Day of The Week

Event Start Time (AM/PM) *

Event End Time (AM/PM) *

Event Location

Event Address & Room name (If applicable) *

Speaker Expectations

Special Instructions

How long will Recorder Heap speak? (Minutes) *

What time will Recorder Heap begin speaking? *

Will there be a Q&A session where Recorder Heap answers audience questions? *

Yes

How many minutes for Q & A *

I consent to photographs and recording of Recorder Heap only. No other parts of the meeting will be recorded. *

Yes

Please be aware that the email message you are about to send is not confidential and is subject to disclosure under the Public Records Law (A.R.S § 39-121 through 39-161). An email sent to this office is a public records and could become part of a future public records request.

Recorder

Speaking Engagement Request

Office and the Recorder

Locations and Hours

Speaking Engagement Request Form