WorldatWork Speakers Bureau

Speaker Request Form

Thank you for your request for a speaker from WorldatWork. Please fill in the information required below and send your request by clicking the submit button. We will contact you regarding the status of your request within seven business days of receiving the completed request form. If you do not hear within the seven-day period, please contact Marcia Rhodes at (480) 304-6885. Thank you.

Organization Information:

Organization name:

Organization Web site URL:

Event Information:

Event date:

Event time:

Event location:

Presentation Information:

Requesting speaker for:

	keynote address
	general session
	workshop
	panel
	membership meeting
	other

What is the presentation topic?

Audience Profile:

Number of attendees:

HR or business audience?

	HR
	business

Speaker Information:

Will the organization reimburse presenter(s) for speaking at this event?

reimburse time
	yes
	no
reimburse expenses (travel, hotel, etc.)
	yes
	no

What led to your decision to invite someone from WorldatWork to speak?

	article
	referral
	local network
	Web search
	other

Event Organizer contact details:

Name:
Title:
Organization:
Phone:
Fax:
E-mail:

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