FSA speaker request form

Details of conference including:

Title; Date; Venue etc.

Details of speech including:

Title; Duration etc

Target Audience including:

Numbers; Market Segment; Level of seniority

Please provide details of the programme including:

Proposed Topics; Agenda; Other speakers invited and confirmed

How and where will the event be marketed?

Has this event taken place before?

Please give details

Have you approached anyone else in the FSA regarding this request?

Please give details

Will journalists be present at this event?

Yes No

Will the speech be recorded or slides distributed?

Yes No

Are you prepared to offer any complimentary places to FSA staff for the event?