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2. Speakers Request Form

   To request a City of Buda representative from among our SPEAKERS BUREAU participants as a speaker or panelist for your event, please complete the following SPEAKER REQUEST FORM in its entirety and submit it, preferably at least four (4) weeks in advance of the occasion. After your request has been reviewed, you will be notified within 5 business days regarding the speaker’s availability for your requested event.  While not every speech request can be fulfilled, the City of Buda thanks you for your interest and looks forward to potentially serving you for a future occasion. If you have questions about this form, please contact LaMarriol Smith at 512-523-1052.

4. Name of the Event:*
5. Date of the Event:*
   Date of the Event:
7. Event Start Time:
8. Hour
9. Minutes
10. Time of Day
    -- Select One --AMPM
12. Event End Time:
13. Hour
14. Minutes
15. Time of Day
    -- Select One --AMPM
17. Exact Speaking Time:
18. Hour
19. Minutes
20. Time of Day
    -- Select One --AMPM
22. Length of Prepared Remarks:*

    1. 5-10 mins
    2. 10-15 mins
    3. 15-20 mins
    4. 20-25 mins
    5. 25-30 mins
    6. 30-35 mins
    7. 35-40 mins
23. Attire:*

    1. Strictly Formal
    2. After 5
    3. Business Professionall
    4. Business Casual
    5. Casual
25. Requested City of Buda Speaker:*
26. Who will be the keynote speaker?*
28. Requester's Name:*
29. Requester's Email Address:*
31. Event Address*
33. Address2
35. City:*
36. State / Province:*
37. Zip:*
39. Organization Making Request:*
41. Remarks / Presentation and Requested Points to Cover:*
43. Acknowledgements in Speech:*
45. If this request is for a panel, please add names of other panelists:
47. Who is introducing our speaker?*
48. Special Guests / Attendees:
50. Contact Name for Event: *
51. Contact Phone Number*
53. Unique Characteristics of Events:
54. Presentation Due:*
    Presentation Due:

    Presentation Due:
56. Estimated Attendance:*
57. Audio / Visual Equipment Available:*

    1. Yes
    2. No
59. Will speakers be audio/video recorded? (Check all that apply)*

    1. Video
    2. Audio
    3. No
60. Do you expect media to attend this event?

    1. Yes
    2. No
62. Powerpoint Requested:

    1. Yes
    2. No
63. Do you need to obtain a high resolution photo of speaker?*

    1. Yes
    2. No
67. Expenses Covered (Check all that apply)*

    1. Hotel
    2. Airfare
    3. Per Diem Meals
    4. Transportation
    5. None
Leave This Blank:


69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit

* indicates a required field