Speaker Request Form

Please note that CNBC talent cannot accept speaker fees or long haul travel and accommodation expenses.

Section 1: Event Details

Event Name

Event Date

City

Region

Website URL

Event Type

Public Conference
Industry Conference
Corporate Event
Charitable Function
Other, Please Specify

Event Access

Event Description

Event Audience Type

General Public
CEOs and Executives
Analyst and Brokers
Students
Philanthropy, Business, Government
Other, Please Specify

Expected Audience Size

Event Fee/Ticket Price to Attend

Section 2: Session Details

Requested Speaker

Session Date

Speaker's Role

Panel Moderator
Master of Ceremonies
Speaker
Panel Member
Other, Please Specify

Start Time (HH:MM)

End Time (HH:MM)

Panel Description/Details

Name of Panelists

Format of Session

Fireside Chat
Panel Discussion
Other, Please Specify

Will there be Q&A session?

Yes
No

Section 3: Recording

Will the event be recorded?

Yes
No

If applicable, please answer below questions. If not applicable, please insert N.A.
(i) Is the recording for promotional purpose, or for a third party?
(ii) What is the intended purpose of recording?
(iii) Where will the recording be published?

Section 4: Requestor's Contact Information

Name

Email

Organization

Telephone

Event Contact Information (if different)

Name

Email

Organization

Telephone

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