Speaker Travel & AV Summary Form  
 
Speaker Travel & AV Summary Form
Speaking Event
If Other, Please List Event: 
Speaker Name: 
Speaker Organization: 
Title: 
Address: 
City, State, Zip: 
Email Address: 
Cell Phone: 
Work Phone: 
Are you travelling by:

TRAVEL ARRANGEMENTS
Arrival Date & Time:
v
:
Arrival Airline: 
Arrival Flight #: 
Departure Date & Time:
v
:
Departure Airline: 
Departure Flight #: 
Sleeping Room Needs:

Note: Hotel room and tax will be charged to Host's master account with the hotel unless otherwise noted on your speaker agreement. Please expense other related incidentals. Hotel confirmation number provided closer to the event date.
If yes, please provide:
Arrival Date:
v
:
Departure Date:
v
:
NOTE: All speakers will have a standard double queen room, unless otherwise noted in your speaker agreement.
Handicap Accessible room required? 
Audio/Visual Requirements:


Additional Set-up & A/V Needs:


Other AV Needs 
NOTE: If you require a special set up, please indicate in the field below. Speaker agrees to arrive at Conference at least two hours prior to start of session.
Other Room Set Up: 
Presentation:

To complete your speaker agreement, an electronic version of your presentation must be sent to the Foundation prior to your presentation.

Handouts: In an effort to “go green” handouts will no longer be provided. Attendees will be given a link after the conference with applicable presentation and materials from the Conference.