Contact Information

Contact Person:  

Position/Title:  

Contact's E-Mail Address:  

Contact's Phone:  

Contact's Secondary Phone:

About the Organization

Organization/Group Name  

Audience Type  

Business Professionals
Civic Group
Faith-Based Organization
Law Enforcement
Seniors
Teens
Other (describe below in comments section)

Presentation Date/Location

Event Date

Event Time

Event Location:  

Physical Address Include building/suite numbers

Arrival Time

Departure Time

Has the FBI ever presented to your organization or group before?  

Yes
No
Unsure

If yes, please include the topic of discussion and estimated date of the presentation.

About the Event

Type of Request Speaker Presentation Booth Other

If other, please explain

Purpose of the Event:  

Number of Attendees Expected   (minimum 25 attendees)

Length of Presentation (e.g. 30-45 minutes)  

Presentation Topic

Choose a topic that suits your event (select all that apply)   FBI Overview Terrorism Community Awareness Presentation (CAP) Cyber Crime Public Corruption Gangs Civil Rights Recruitment and Hiring Youth-Based Presentation Other (describe below in comments section)

Other Event Information

Will there be Q&A afterwards?  

Yes
No

Will there be audio/visual equipment available for PowerPoint slides?  

Yes
No

Is a bio needed for the speaker?  

Yes
No

Will media be present?  

Yes
No

Will the event be held indoor or outdoor?  

Indoor
Outdoor

If outdoor, will a tent be permitted?

Yes
No

Will tables/chairs be provided?  

Yes
No

Do you plan to do any publicity related to this event (either before or after), including through press releases, websites, blog posts, photos, or other means?  

Yes
No

If yes, please explain.

Will attendees be charged a fee to attend?  

Yes
No

If yes, please explain.

Will there be the marketing, selling, or promoting of any products/services at this event?  

Yes
No

If yes, please explain.