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Speaker Request Form

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Speaker Request Form

To request a member of the ANCOR team to speak at your event, please complete this online form (fields marked with an asterisk are required).

Costs and Requirements

I agree that my organization will (upon invoice with receipts attached):

  • Reimburse the cost of round-trip travel (including roundtrip mileage to the airport and parking if applicable. Mileage in staff’s personal vehicle will be reimbursed according to current IRS rate).
  • Provide or reimburse hotel accommodations for night(s) (please let staff member know if they need to make their own hotel reservation).
  • Reimburse the reasonable cost of meals.

Additionally, my organization agrees to:

  • Provide an electronic roster of participants/registrants and exhibitors with full contact information immediately following the event.
  • Place a ½-page ad provided by ANCOR in conference program at no cost to ANCOR (if applicable).
  • Include material provided by ANCOR in registration packets or handed out to participants.

In lieu of a speaker fee, we request a voluntary $500 contribution to the ANCOR Foundation for each staff member that speaks at your event.

ANCOR staff will be in contact with you shortly to confirm availability for your event and to discuss any additional details or logistical arrangements needed.

Contact Information
Event Details
Type of Event
Location of Event
Topics to be covered (check all that apply)