ESR Speaker Request Form

It is Fannie Mae's policy to approve all events before any Fannie Mae representative can consider them. Please submit the requested details below.

All fields are required.

Event Name:

Organization Hosting the Conference:

Requested Speaker:

Appearance Date:

Speaking Time:

Event Location

Event Address

City

State

ZIP Code

Event Coordinator Contact Information

Requestor Name:

Email:

Office Phone:

Cell Phone:

Presentation Details

Speaking Topic and Length:

Keynote or Panel Discussion:

Panel

Keynote

Who will introduce Speaker(s)?

Name:

Title:

Is a PowerPoint needed? If so, what is your proposed due date? Please note that due to the nature of content, no earlier than a week in advance is appreciated.

Yes

If available, what is the speaker's agenda?

(Example: "Speaker arrives at Ballroom 1 at 8:15 a.m. for sound check. Speaks from 8:30 -9:30 a.m. Can leave after 9:30 a.m.")

Audience Size and Type (industry, sector, executives, residential, commercial, etc.)

Size:

Type:

Attendance

Any additional speakers at your event? If so, please list:

Is this a Fannie Mae sponsored event?

Yes

Will there be any elected officials participating/attending (if yes, who)?

Yes

Will any press or media attend the event (if yes, who)?

Yes

Logistical Requirements

Travel Expense Coverage (Flight, hotel, incidentals, etc.)?

Flight:

Flight

Hotel:

Hotel

Other…

Other:

Will expenses be paid up-front or reimbursed?

Up Front

Reimbursed

If the event requires ground transportation, will you be making arrangements on our speaker's behalf:

Yes

Any other schedule considerations or additional notes?

(Example: Do you plan to invite the speaker to a reception before the speaking engagement or afterwards? If so, location of the reception? Reception attire?)

Math question 9 + 0 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.