ICBA Speaker Request Form

Host Organization Information:

*Primary Business of Organization:

Event Information:

*Type of Event:

Audience Description:

Who will be in attendance?

Speaker Platform Information:

*Type of Presentation:

Other events you would like to invite the speaker to attend?

Travel & Accommodation:

Will you provide transportation to/from airport & hotel?

if so, please describe what type of transportation you will arrange.

Will speaker’s room reservation be made by you?

Speaker Honorarium/Fee:

ICBA does not charge an honorarium or fee for speakers. However, depending upon the type of event a/o request, we may request the host organization to assist in the expenses incurred in travel and lodging.
*Do you have a speaker expense budget for event?:

Alternative Speaking Options:

Due to the nature of Government Relations work, ICBA Government Relations staff may not be available to speak in person at the time your event takes place. We may, however, be able to make an audio or video teleconference presentation.
*Does event location have audio/video capability?

*Are you willing to explore this option, if needed?