Speaker Request Form

Event Data/General:

Name of Event:

Location:

Email:

Audience background:
Developer 
IS 
Management

Technical Level of Audience:
High  
Medium 
Low

Knowledge Level of OT :
High  
Medium 
Low

Presentation Topic:

Key Issues to be addressed:

Format of Session:
Formal 
Roundtable
Other

Amount of Time Allocated:

Travel Expenses, will you as the host cover expenses?
Yes
No

Location Specifics For Corporate Events:

Division:

Primary Industry:

Current OMG member?
Yes
No

Date Requested:

Alternatives Dates:

For Tradeshow/Conference:

Primary Event Focus:

Time of Session:

Please, type (or highlight and drag-and-drop) this code 3TMw8 into the field below, to complete the registration.