Board Member Special Appearance Request

Host Organization

Organization Contact Name

Contact Email

Phone Number

Event Date

Event Start Time

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Estimated Event Size

Brief Description of Event

Board Member Role

Briefly describe the role you envision for the Board member in attendance (I.E.: prepared speech, Q&A, panel discussion, meet & greet, etc.). If the board member will be speaking, please describe the general subject(s).

Will you be publicizing the event?

Yes

If yes, please briefly describe your anticipated outreach

(I.E.: social media, email or print newsletter, press outreach, etc.)

NOTE: Any promotional materials MUST be submitted to the Board for approval.

Welcome

Board Member Special Appearance Request