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MGI Speaker Request Form
ORGANIZATION NAME
*
TITLE OF EVENT
TOPIC(S)
EVENT LOCATION
EVENT DATE
TIME
URL OF EVENT WEBSITE
TELL US A LITTLE ABOUT THE CONTRIBUTION THAT YOU WOULD LIKE THE MGI SPEAKER TO MAKE: E.G. PANEL MEMBER, KEYNOTE SPEECH, ROUNDTABLE
*
DURATION OF MGI PRESENTATION: (30 MINUTES, 1 HOUR, ETC.)
WHAT IS THE EXPECTED AUDIENCE FOR THE EVENT?
Private Sector (C-suite)
Public Sector
Academic/Think tank
Private Sector (other)
Social Sector
Students
IS THIS EVENT OPEN TO MEDIA?
*
YES
NO
WILL IT BE ON THE RECORD?
*
YES
NO
WILL THE EVENT BE RECORDED ON VIDEO?
*
YES
NO
WILL THE EVENT BE STREAMED LIVE?
*
YES
NO
WHO ARE THE SPONSORS OF THE EVENT, IF APPLICABLE?
ARE ANY OTHER ORGANIZATIONS ENGAGED IN THE EVENT? IF SO, PLEASE LIST AND INCLUDE DETAILS OF INVOLVEMENT?
NAME
*
JOB TITLE
*
EMAIL
*
TELEPHONE
*
Submit