MEMBER ZONE
SEARCH NATIONAL SITE
SECURITY LEVELS

Speakers Bureau Request Form


Request for Coast Guard Auxiliary Participation in Public Events
(Auxiliary Speaker's Bureau) 

Purpose: This form is used to request a member of the U.S. Coast Guard Auxiliary to seek at a public event. The information below is required to evaluate the event for appropriateness and compliance with Homeland Security policies and for coordination with the units involved. Please complete all applicable sections.

General Information

Name of Event and expected audience. Please write out acronyms!

Today's Date

Date, Time and Location of Event

Person Completing Form (Point of Contact)

Point of Contact's e mail Address

Point of Contact's Phone Numbers

Point of Contact's Time Zone & Best Time to Call


Project Information

Purpose of the Event. Please be specific!

Who is Your Audience? example: other Auxiliarists, general boating public, children, staff officers, conference participants) Do you have any VIPs or special visitors attending?

Is there a charge for this event?
Yes  No


Have you invited media? If so, please specify:
Yes No    


Program or general itinerary of event: 

Is the public invited to this event?
Yes No

Can you find other venues for the speaker if he/she travels to your location?
Yes No

Is this event being used to raise funds? If so, please explain.

Yes  No

Is your group advertising the event? If so, how?
Yes No

 


Sponsoring Organization Information

Contact Information for the Organization

Point of Contact at Organization and Title

Point of Contact's e mail Address

Point of Contact's Phone Numbers

Point of Contact's Time Zone and Best Time to Call
 

Organization Specifics

Is your organization a ...
Civic Organization
Government Organization
Other (please specify) 

 

Does your organization exclude any person from its membership or practice any form of discrimination in its functions based on race, creed, color, sex, or national origin?
Yes No

 

Can your organization provide computer and/or audio-visual equipment?
Yes No 

 

Is your organization willing to provide funding for any expenses when the requested military resources are not local to the geographic area of the event and not within the budget of the command? If so, please specify in terms of travel, lodging, meals, etc. 
 YesNo

 

General Project Comments or Instructions

Comments or Instructions you would like to make

 

Type PA%wh1ot here (anti-SPAM) :

     

 

Thank you for using our on-line request form.  You will be contacted by one of the members of the Speakers Bureau.