Speaker Request Form

This form may be used to request a member of the Office of Broadband and Digital Literacy (OBDL) or Middle-Mile Broadband Initiative (MMBI) to speak at a future event. Please fill in the form below with as much detail as possible. Please contact broadbandforall@cdt.ca.gov for any technical questions.

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Requestor Information

Name: *

Title/Classification: *

Organization: *

Email *

Phone

What is the best way to reach you? *

• Email
• Phone
• Both

Event Details

Requested OBDL/MMBI Speaker: *

Event Title: *

Event Date: *

What time should the OBDL speaker be present at the event? *

Please specify timezone (e.g. PST, CST, EST, etc.)

Please provide a brief description of the event.

What is the format of the event? *

• In-person
• Virtual
• Hybrid (in-person & virtual)

Please provide the in-person location and address, if applicable.

Event Website or Promotional Link (if available):

Will the event be recorded and/or broadcasted? *

• Yes
• No

Event Format (Check all that apply):

• Keynote
• Panel
• Roundtable
• Speaker
• Q&A
• Workshop
• Seminar

Please describe what topics you would like the speaker to cover. *

What resources are needed in preparation for this event? Check all that apply.

• Headshot photo
• Biography
• PowerPoint Slides
• None
• Other:

If selected "Other" in the previous question, please list the additional resources needed below.

the been Please

Who has been invited/will be speaking at this event? Please provide their full name, title, & organization.

Will media be present?

• Yes
• No
• To be determined

If “To be determined” is selected, please notify OBDL/MMBI as soon as possible.

Intended Audience:

Ex: general public, broadband consortia, internet service providers, etc.

Audience Size (if known):

Additional Comments or Notes:

Submit