Face the Fight Speaker Request Form Question Title * 1. Your Name Question Title * 2. Your Email Question Title * 3. Event Host (Organization) Question Title * 4. Organization Type For-Profit Non-Profit Association Academia Government Agency Other Question Title * 5. If you answered 'Other' please elaborate: Question Title * 6. What is your relationship to Face the Fight? Coalition Member Donor Grantee Friend Other Question Title * 7. If you answered 'other' please explain your relationship to Face the Fight: Question Title * 8. What is the date of the event? Please list the month, day, and year if known. Question Title * 9. What is the due date for a response? Date Date Question Title * 10. Where is the location of the event (Please include street, city, state, and zip code)? Question Title * 11. What is the purpose of the event? Question Title * 12. What is the objective of the presentation? Question Title * 13. Link to event website: Question Title * 14. What is the topic you want the speaker to cover? Example: Technical on data, general overview, military/ veteran perspective, lived experience Question Title * 15. Please indicate if you have a specific speaker you want to request. Question Title * 16. Are there any additional speakers you wish to request? If so, please list their name(s): Question Title * 17. What is the presentation style? In-person Virtual Hybrid Question Title * 18. What is the presentation style? Keynote Pannelist Short Remarks Other Question Title * 19. If you answered 'Other' please describe the presentation style: Question Title * 20. What is the length of the presentation? Question Title * 21. How many people do you expect to attend the presentation? Question Title * 22. What is the demographics of the audience? Military VSO Scientific Healthcare/Clinical Academic Corporate Military ERG Non-profit Other Question Title * 23. If you answered 'Other' please elaborate: Question Title * 24. Is the event open to the public? Yes No Maybe Question Title * 25. Will the media be invited to the event? Yes No Maybe Question Title * 26. What, if any, are the AV requirements? Question Title * 27. Will the event be recorded? Yes No Question Title * 28. If yes, how will the recording be used? Question Title * 29. How long will the recording be available? Question Title * 30. How will the recording be used? Question Title * 31. Is the organization willing to cover the cost of travel and accommodations? Yes No Question Title * 32. Does the event/organization have a relationship with USAA? Previous grantee Affinity Relationship Military Affairs USAA Sponsored Other Question Title * 33. If you answered 'Other' please elaborate: Question Title * 34. Does the organization have any relationships with any of the following: Elizabeth Dole Foundation Humana Research Reliance University of Texas Health, San Antonio None Done
