Recorder

Speaking Engagement Request

Speaking Engagement Request Form

Organization Details

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

Organization Website *

Contact Information

Contact First Name *

Contact Last Name *

Contact Email *

Contact Phone Number *

Event Details

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 Information

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

Review and Submit

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.