Request a speaker

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Name*

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Professional Title*

Organization*

Email*

Phone Number*

Business Address

Address

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Event Overview

Sponsorship Organization

Name of Event

Event Start Date*

Event End Date*

Event Start Time*

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Event End Time

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Event Description*

Event Location

Additional Event Information

Estimated Number of Attendees

List of press/media in attendance

Will there be other speakers?

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List speakers

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Remarks / Participation Request

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Welcoming remarks (3-5 minutes)
Short Remarks (5-10 minutes)
Speech (15 - 20 minutes)
Major address (20 minutes +)
Additional time for Q & A
Additional participation (explain below)
Other (explain below)

Comments

Important Information

Event materials (program, guest list, copy of brochure or invitation, etc.) must be submitted to admin@caipe.org at least seven days prior to the event. Additional materials may be requested as needed. Please notify us at admin@caipe.org immediately regarding cancellation or any changes to the event as well as delays in providing event materials. Requestors are not authorised to use the CAIPE name or logo for promotional purposes until a confirmation of attendance has been sent by CAIPE staff. Thank you.

Agreement*

I have read and understand the Important Information section of this form.

Once event participation is confirmed, I authorise CAIPE to publicise my event on CAIPE's event calendar.

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