ASHRM Speaker Request Form Welcome To request an ASHRM speaker, please fill out the request form below and provide as much information as possible about the event. Note: This form does not guarantee the availability of the speaker. Question Title * CHAPTER OR ORGANIZATION NAME Question Title * CONTACT INFORMATION Your Name Position Held in Chapter or Organization Your Phone Number Your Email Address Question Title * Please describe the speaker details you are looking for. Fees may be required depending on the type of request. Question Title * EVENT INFORMATION Title of Event Date(s) of Event Time of Presentation Length of Presentation Venue/Location of Event (Please provide the Venue's location, address, city, and state) Please Provide Any Other Information Regarding the Event Question Title * EXPECTED ATTENDANCE 0-25 25-50 51-100 101-150 151-250 250+ Question Title * ASHRM AVAILABLE SPEAKER TOPICS ASHRM Update Customized Content (customized content request will be reviewed, but can't be guaranteed) ASHRM Update •Fee—Free upon request•Expenses—For speaker travel and accommodations, contact ASHRM for more information. Customized Content•Fee – quote will be provided – explain custom content request below in additional comments•Expenses – Speaker travel and accommodations paid by chapter or organization Question Title * Please provide details of the customized content you would like Submit