Request a Speaker

Organization Name

What is your ACA Affiliation?

Full Event Name

Event Website

Social media handles of org and event, including any hashtags

Is the event...

Virtual

Live

Is there a need for a Podium sign and or background?

Podium Sign

Background

Both

Is the date the Speaker requested flexible?

Yes

No

Is the time the Speaker requested flexible?

Yes

No

Please list other keynote speakers – either confirmed or under consideration

Please describe your attendees demographics (include career phase and professional Identity)

Number of Attendees

What is the topic for the Speaker?

Honorarium *ACA policy prohibits accepting honorariums

Is there a Travel and Lodging budget?

Yes

No

If there is a Conference Block please provide details below

Is ACA responsible for charges?

Yes

No

What are the Key due dates for the bio and headshot?

What are the Key due date for the deck(s)?

Will it use a branded slide deck or ACA branded?

What are the IT / AV requirements?

Can speaker request headset, etc?

Yes

No

Number of words for bio

How will this be marketed?

Are there CEs offered?

Yes

No

If Yes, by whom?

What is the timeline?

Can we get a contact list of the attendees?

Yes

No

If Yes, upload list here

Will there be an expo hall?

Yes

No

Will there be attendee materials provided?

Yes

No

What are our options to provide materials?

Will the deck be sent to attendees?

Yes

No

If Yes, How?

Will there be a confirmed media presence?

Yes

No

If Yes, please list below

Any additional information for consideration?