Book A Speaker Form – Office of the Treaty Commissioner

Business / Organization

Description of Organization and Organization Mission

Conact Title

Contact Name

First

Last

Email

(Please specify) (if

Phone

Type of Request

* Please note that fees for Speaker’s Bureau engagements vary depending on type of request.

Other Type of Request:

Event Name

Event Description

Event Date

Date

Time

* Include start time and finish time. Please indicate if request is for a multi-day event.

Other speakers at event (if applicable)

Event Location Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Potential Audience Size

Greater than 500 guests, please specify

Subject/Topic

Audience Type

Speaker Request (if applicable)

Other OTC Member (Please specify)

How long is the presentation?

Additional Information