Speakers Bureau

APPLICATION FOR THE NCDA SPEAKERS BUREAU.
Applicants must be NCDA members and offer programs appropriate for our membership.
This is a NCDA Leadership Academy III Learning Project created by By Gemma A. Williams
E-mail Gemma at gemmaw@hawaii.edu with questions.
Please answer the following questions by
placing an X in the appropriate box or
filling in the blanks:
Contact Information:
Name
Full Address
Phone
Email
Website
NCDA Membership Number
1. Please write the title of the presentations
you made in the last 5 years and check appropriate
categories: International, National, or State.
2. Check the delivery methods you offer and specify
how much you charge for your sessions:
On-site - fee: Does this include
travel? Yes No
accomodations Yes No
honorarium? Yes No
On-line - fee:
Webinar - fee:
Other? - Specify type and fee
Negotiable? - Specify:
Other Media (e.g. DVD, CD, Audio or Video Tapes)- fee:
3. What format do you use?
If "Other" Please Specify:
4. What is the length of your presentations/sessions?
If "Other" Please Specify:
5. Are there specific times during the year that
you cannot offer your presentations/sessions?
6. Do you offer handouts?
7. Is there an additional charge for your handout?
8. Do you offer any follow-up or assistance following your presentation?
No
Yes Please Explain:
9. List at least two state association’s presidents or
officers that can be contacted for references.
10. How much advance notice do you require for scheduling?
Additional Comments:
   - denotes required fields