Speaker Request

National Indian Gaming Commission Speaker Request Form

Thank you for your interest in having an NIGC speaker at your event. In order to help us facilitate your request, please complete, save, attach and submit the following form at least 30 days prior to the event (to allow for appropriate travel accommodations to be made should request be accepted). Please allow 3-5 business days for decisions to be made.

If you have any questions or need help completing the Speaker Request Form, please call the NIGC’s Legislative and Intergovernmental Affairs Specialist (LIAS) at 202-632-7003.

Part 1: Event Organizer

Name of Organization Submitting Request

Event Sponsor(s)

Select one

For-Profit
Not for Profit
Both

Coordinator/Point of Contact Name

Coordinator/Point of Contact Title

Phone

Part 2: Event Details

Event Name/Title

Event Location

Event Date / Time

Date

Time

Event Type

(conference, dinner, small group, etc.)

Event Purpose/Goal

Event Website

(if applicable)

Part 3: Presentation/Speech Details

Requested Topic

Presentation Format

(keynote address, roundtable, panel, etc.)

Expected Duration

(30 minutes, 1 hour, etc.)

Question and Answer

(Will the speech be followed by a Q&A session?)

Part 4: Audience Details

Audience

(Approximate size of the audience. Also briefly, describe its make-up and if membership is required to attend.)

Honorable Guests

(List names and titles of members of Congress, CEOs, or other VIPs participating in, or attending the event.)

Media

(Will media be invited? If so, will the event be open or closed press? Also describe and submit media list.)

Part 5: Additional Information

Deadline for Acceptance

Cost of Attendance

(please include member and nonmember price, if applicable)

Offer of Payment/ Reimbursement

(none, dining, lodging, travel, etc.)

Disclaimer/Release Form

(Please indicate whether or not the event sponsor will need the speaker to sign a disclaimer/release form.)

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