NCDA Board Speaker Request Form

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Please complete this form to request a NCDA Board member to speak at your state CDA event. If approved, NCDA will cover the travel costs for a Board member to speak at your CDA event. This form will help streamline the request process which ideally results in an equitable process for all state CDA speaker requests. Please view the Board Travel Policy or contact the NCDA State Trustee for more information.
*All Responses Required
State:
City or regional location within state:
Name of person requesting a speaker:
Email:
Phone:
Event description/concept:
Event date (a target month is fine):
Anticipated number of attendees:
Board member requested:
Topic on which to speak:
Speaker time length:
Date by which you need to confirm speaker:
The second choice for board speaker:
Topic:
Funds being contributed by state CDA to overall event:
What value do you see the board member speaker adding to your event?
   - denotes required fields