Directions: Use the form below to submit a request to have Dr. M. Christopher Brown II as a guest speaker. You may also download
and email/fax the Speaker Request Form.
Event Information
Organization/Host Name:
Name of the event:
What is the date(s) of the event?
What is your preferred time for Dr. Brown’s presentation?
Are there alternative speaking times?
What is the location of the event (city, state, and venue)?
What topic would you like Dr. Brown to address?
Do you want Dr. Brown to serve on a panel, deliver a speech, or other?
If this request is for a panel presentation, please identify who else will be invited to serve as a member of the panel?
How long is Dr. Brown invited to speak?
Are there any other speakers in addition to Dr. Brown?
Are there any competing concurrent sessions?
If so, please describe them.
What is your proposed agenda for the day (e.g. an attached outline)?
How many attendees are expected? Who will be in the audience?
Is this event open to the press (including internal communications staff)?
Will there be an LCD projector and laptop available for the presentation? (Note: Please let us know if other speakers will be using Microsoft PowerPoint.
Dr. Brown would like to be consistent with other speakers.)
Do you need a biographical sketch and picture of Dr. Brown?
How will costs for travel be handled?
Are there any other special considerations that should be taken into account as Dr. Brown makes his travel arrangements?
Is there anything else Dr. Brown should know about this meeting?
Contact Information
Invitational contact person:
Please supply the name and mobile phone number of someone from your organization who Dr. Brown can contact on the day of the event.
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