Speakers Request

To request a Florida Chamber of Commerce speaker, please fill out the entire request form below to provide as much information as possible about the event.

* Required Field

REQUESTER INFORMATION:
    
    
  First Name*  
  Last Name*  
  Title*  
  Company*  
  Address  
  Suite No.  
  City  
  State*  
  Zip Code  
  Email*  
  Phone*  
  Is your organization a current member of the Florida Chamber of Commerce or Florida Chamber Foundation?*  


EVENT OVERVIEW:
    
    
  Name of Event*  
  Event Date*  
  Event Time*  
  Specific time presenter will speak*  
  Event Location*  
  Event Address*  
  Event City*  
  Event Zip Code*  
  Request:  
     
  Name of Requested Speaker*
    Name of Requested Speaker*  
   
   
   
   
   
   
   
   
   
   
   
   
   
   
     
  General Focus of Remarks*  
  Estimated Length of Remarks*  
  Number of Expected Attendees*  
     
  Description of Audience
  Description of Audience*:  
   
   
   
     
  Will there be press in attendance?*  
  If yes, which media outlets have been invited?  
     
  Costs covered by the requesting organization include:
  Costs covered by the requesting organization include*:  
   
   
     
  Room Set-Up*:  
     
  A/V Options Available
  AV Available*:  
    
    
    
    
    
    
      
      
  Event Description*  
      
      
  Background Information on Your Event*  
      
      
  Proposed Agenda*  
      
      
      
      


Be sure to check your information for accuracy prior to selecting the submit button below.
   
 
Please click submit only one time.  The transaction may take several seconds.