AAPA Speaker Request Form

Please submit this form to request a visit by an AAPA Leader. Requests must be submitted at least 12 weeks in advance of the desired event date to ensure time for appropriate review and planning. The form is designed to capture as much information as possible to inform the decision-making process; however, you may be contacted for additional information. A staff member will reply to your request as soon as possible.

Please contact governance@aapa.org with questions or if you require assistance. Thank you.

Basic Information

Event Name *

Event Venue and Address (e.g. Big City Convention Center, 100 Main St., Anytown, ST) *

Date of Presentation *

Time of Presentation (If currently unknown please enter "TBD") *

Name of organization requesting a speaker (please no acronyms) *

Primary Point of Contact *

Title *

Email *

Phone Number *

Organization or event web address *

Presentation Information

Preferred Presenter (Speaker is determined based on availability and topic). *

AAPA President

AAPA CEO

Other AAPA Board Member (Please specify below)

AAPA Staff Member (If name is unknown, please specify department below)

Other (Please specify) Other (Please specify)

Specific Board Member, Staff Member, or Department

Please describe the opportunity for which you are seeking a leader and provide as much detail as you have at this time.

Format (e.g. keynote address, Town Hall remarks with audience Q&A, Advocacy presentation, panel presentation, etc.) *

Topics or themes requested for presentation *

Audience size and composition *

External stakeholders involved *

Anticipated media coverage *

Other opportunities of interest/opportunities for the speaker to meet with your leadership. *

If the invitation relates to a session with multiple speakers, please list the other invited speakers. *

If AAPA is not able to schedule a presenter to come to your event, are there virtual options we can explore? *

Please provide a preliminary copy of your program agenda, if available. AAPA requires that the name and position of AAPA representative(s) be listed in the final printed and online programs.

Additional Comments/Questions

Other comments/questions/specific requests *

Thank you for your request.