Chapter Speaker Request Form for IAEE Leadership/Staff

* Required Fields

Chapter Name:*

—Please choose an option—Central Texas ChapterDallas/Fort Worth ChapterDePaul University ChapterGeorgia State University ChapterJohnson & Wales University ChapterMexico ChapterMidwestern ChapterMid-South ChapterNew England ChapterNew York Area ChapterNorthern California ChapterRocky Mountain ChapterSoutheastern ChapterSouthwest ChapterUniversity of Houston ChapterUNLV Student ChapterWashington DC Chapter

Contact person:*

Contact email:*

Contact phone:

On-site contact person:

On-site contact's mobile phone:

Date of Event:

Time of Event:

Choose from the following speakers:

IAEE Chairperson

IAEE Chairperson-Elect

David DuBois, CMP, CAE, FASAE, CTA, IAEE President

Cathy Breden, CMP, CAE, CEM IAEE Executive Vice President & COO/CEO, CEIR

Other IAEE Board Member

Other IAEE Staff Member

If you chose "Other IAEE Board Member" or Other IAEE Staff Member", please include their name below:

Desired Topic:*

Type of event (breakfast, luncheon or networking event)*

Location of program (include address or virtual):

Expected attendance: *

Will chapter make hotel and ground transportation arrangements?

—Please choose an option—yesno