Request a Speaker

Looking for a ASA representative to speak at your congress or event? Please complete this form to submit your request. Please permit up to two weeks for a response, and please note that due to our small size, we may not be able to accommodate your request.

Organization

Contact Person

First Name

Last Name

Email Address

Please double-check for typos! We have no way to reach you if there was a mistake in your email address.

Phone Number

Country

(###)

###

####

Event Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Event Date

YYYY

Event Time

Hour

Minute

Second

Time Commitment

Language of the Presentation

Audience Size

Event Focus

Request Type

Speaking Topic

Travel Expenses Provided

None

Air / Train Travel

Hotel

A/V Equipment Available

Projector

Screen

Speakers

None

Do you need speaker's bio?

Do you need the speaker's picture?

Will press be present?

Anything else?

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