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OFFICER AND EXECUTIVE COMMITTEE SPEAKER REQUEST FORM
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Officer and Executive Committee Speaker Request Form
NEA Officer Requested
- Select -
Becky Pringle
Princess Moss
Noel Candelaria
Kim Anderson
Bill Farmer
Tia Mills
Shannon McCann
Mark Jewell
Gladys Marquez
Ronald “Duff” Martin
Karen White
2nd Officer for training or Alternate Speaker
- None -
None
Becky Pringle
Princess Moss
Noel Candelaria
Kim Anderson
Bill Farmer
Tia Mills
Shannon McCann
Mark Jewell
Gladys Marquez
Ronald “Duff” Martin
Karen White
Requested Date
Requested Speaking Time
Time Zone
Eastern
Central
Mountain
Pacific
Alaska
Hawaii
Other, i.e., International
Enter other…
Event Start Time
Event End Time
Sponsoring Organization
Event Title
Event Theme
Will this event be held virtually?
Yes
No
Are videotaped remarks preferred/requested or is an acceptable option to attend via live web conferencing?
Video please
Web Conferencing Preferred
Date Needed
Web-Conferencing Technology (if available)
Web-Conferencing Technology (if available)
- None -
Zoom
Web-Ex
Google
Adobe Connect
Teams
GoToMeeting
Webex Meetings
Skype
AnyMeeting
Other (Brief Explanation – under 100 characters)
Enter other…
Web Link (if available)
Meeting ID (if available)
Dial-In (if available)
Passcode (if available)
Is this event located outside of the United States?
Yes
No
Event Venue
Venue Information
Event Address
Event City
Event State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Event Country
Event Zip Code
Hotel and Transportation
Event Hotel
Hotel Address
Hotel City
Hotel State
- None -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Hotel Zip Code
Hotel Phone
Hotel reservation confirmation number
Suggested (closest) airport or train station
Transportation provider name
Transportation provider phone
Transportation provider cell
Remarks Required?
Yes
No
Best person to contact for remarks
Full Name
Phone
Email
Approximate Format
- Select -
Welcome/Greeting/Informal (3-5 minutes
Short Remarks (5-10 minutes)
Speech (10-15 minutes)
Panel Discussion (20 minutes+)
Featured Keynote (20 minutes+)
Training (Racial Justice Education)
Training (Other)
None
Expected Attendance
Last Year's Attendance (if applicable)
Meeting Participants/Audience: What groups, individuals and/or organizations are participating? Cite any notable persons that may attend ? education leaders, lawmakers, etc.
Are other activities planned with this event that will include speaker?
Yes
No
If yes, please explain
Purpose: Why is it important for NEA leadership to attend and what is the desired outcome?
History/Background: e.g. What does leadership need to know about the audience, organization or individual meeting participants? What is NEA's relationship with the group?
Major Topics of Discussion: What are the major issues being discussed at this event/meeting?
Will there be Q&A?
Yes
No
What questions should leadership be prepared to address/answer?
Are there other notable speakers invited and/or confirmed on program?
Yes
No
If yes, please provide name, title and organizations:
Have you produced/plan to produce a press release for this event?
Yes
No
If yes, please provide copy of release
Have any media been invited or confirmed on the webinar?
Consult with experts to identify
IF
press release and/or media outlets are relevant during COVID.
Yes
No
If yes, please provide media contact(s) name & telephone
Primary Contact Information
Primary Event Contact
Title
Primary Phone
Address
City
State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federal Education Association
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other
Zip Code
Email
PR/Media
PR/Media Contact Name
PR/Media Contact Phone
PR/Media Contact Email
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