This form is to request our 2020 President, Richard Waystack, CRS to speak at your meeting. Please fill out the form and provide all necessary information and we will do our best to accommodate it. However, submitting the form does not guarantee acceptance as it is based on availability.

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* 1. Requester Information:

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* 2. Note: It is the States responsibility to cover travel/accomodation expenses for the speaker. To agree, please select Yes below.

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* 3. Event Name:

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* 4. Event Host:

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* 5. Event Type:

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* 6. Date of Presentation:

Date
Date

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* 7. Time of Presentation:

Time

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* 8. Length of Presentation

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* 9. Event Facility:

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* 10. Event City:

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* 11. Event State:

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* 12. Audience Size:

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* 13. Additional Audience Info:

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* 14. Select Topic:

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* 15. Any additional information or special requests you would like to include, please provide below:

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