NCAA Membership Services Group
Speaking Engagement Request Form

All fields required except those labeled in gray.

Name of group
requesting a speaker:

Subject of
presentation:

Anticipated number
of attendees:

Position(s) of those
expected to attend:

Date of speaking
engagement:

Time and length
of presentation:

Location of
the function:

Is the group willing
to pay travel expenses?

Yes    No
Please explain:

Contact Information

Name:

Title:

Company:

Address:

Phone:

Fax:

E-mail: