speaker request form

Invite Dr. Ravi Singh To Speak

Event Primary Contact

Is the Primary Contact the same as the “Day of the Event” Contact?

Event Details

Additional Information

If a PowerPoint will be used during a presentation, is it acceptable for the presentation to be provided via flash drive?
If a PowerPoint will be used during a presentation, will a projector and a computer be provided for the speaker?

Costs Incurred by Speaker

Will all travel and lodging costs for NHSA staff be covered by the requester?

acknowledgement

By clicking yes, the requester is in agreement to pay for all of the speaker's costs including travel, meals, and any other possible expenses. Please sign your name below.

Please include who should receive invoicing (usually 30-60 days, post event)

Thank you for your submission! We will get in touch as soon as we can!
Oops! Something went wrong while submitting the form.