WIM Speakers Bureau Request Form | American Trucking Associations

Requester's Contact Information

First and Last Name

Tile and Company

Date of Request

If a specific speaker is requested, please indicate name or title of person.

Name of Organization

Dates of Meeting

Location of Meeting

Hotel/Resort Name

City

State

Date and Time of Presentation

Type of Presentation

Duration of Presentation (Excluding Q&A)

Will there be a Q&A? If so, for how long?

Name of Session

Please provide issues of interest you would like to be discussed.

Please provide a submission date of bio and/or photo if required.

Will there be other ATA Staff members attending or speaking at this meeting?

Approximately how many attendees do you traditionally have at your meeting?