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                DOT on YouTubeMenu HomeSpeaker Request Form
Thank you for your interest in having the Federal Motor Carrier Safety Administration speak and present at your event. So that we can give your invitation full consideration and make a prompt decision, please provide as much detail as possible 30 days in advance of the event date. Under ordinary circumstances, expect to hear back from us within 7 to 10 business days of receiving your request.
      
            Contact InformationNameTitleBusiness TelephoneBusiness EmailOrganization NameType of organization
                    
- Select -CMV AssociationBus IndustryGovernmentTruck IndustryOtherIf other, please specifyEvents DetailsEvent TitleEvent Website and/or Company WebsiteEvent Host OrganizationEvent DateEvent TimeDate and Time for Speaker/PresenterLocationVenue Description/Layout of the RoomEvents ParticipantsTarget AudienceAnticipated Audience Size
                    
- Select -10 to 5051 to 100101 to 200201 to 500501+Presentation/TopicRequested TopicRequested FMCSA Speaker/PresenterType of Presentation
                    
- Select -KeynoteRemarksPanelists PlenaryPanelists BreakoutModeratorOtherIf other, please specifyLength of Presentation
                    
- None -5 to 10 minutes10 to 20 minutes20 to 30 minutesWill speaker be expected to answer audience questions following their remarks
                    
- Select -YesNoIf yes, will the questions be written and pre-submitted or ask/answered on the spot?Are you willing to accept a surrogate if your first choice is not available?
                    
- Select -YesNoHave  FMCSA staff/leadership spoken at previous events? If so, who, where, and when?What is the response due date?Media Plans?
                    
- Select -OpenClosedConfirmed CoverageAre there exhibitor opportunities?
                    
- Select -YesNo
Department of Transportation U.S. DEPARTMENT OF TRANSPORTATION

**Federal Motor Carrier Safety Administration**

1200 NEW JERSEY AVENUE, SE

WASHINGTON, DC 20590

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