Chairman Request Form

Chairman Speaker Request Form
Please complete and submit this form to request the NCUA Chairman's participation at your upcoming event. For all other speaker requests, please visit
the NCUA's Speaker Request Form.

How Speaker Requests are Evaluated
Speaking requests that will require travel from the NCUA headquarters in Alexandria must be submitted a minimum of 90 days in advance for
consideration. Internal and external speaking requests that are received less than 4 weeks out from the event date are less likely to be approved.

The NCUA Blackout Periods
Please note that, generally, NCUA staff members do not speak publicly during the week of an NCUA Board Meeting, which typically take place the third
Thursday of the month, excluding the month of August. This time is referred to as the NCUA blackout period.
Indicates required field

1. Event Details
Title of Event
Is this meeting being held virtually? 
- Select -

If yes, please choose the platform being used
- Select -

If this is a virtual event, will this be
- None -

Event start date
mm/dd/yyyy

Event start time
--:-- --

Event end date
mm/dd/yyyy

Event end time
--:-- --

2. Date and Time of Speaker Participation
Speaker participation date
mm/dd/yyyy

Speaker participation time
--:-- --

Speaker participation date and time is flexible
- Select -

3. Location
Please include name and street address of location
of where the event is being held

Event city
Event state
- None -

4. Event Information

Background or purpose of event

Have you invited any other NCUA representatives to
attend the event?
- Select -

If yes, please specify who else was invited
Proposed role
- Select -

Proposed length of remarks, panel or chat
Topic(s) to be discussed

Do you anticipate audience Q&As?
- Select -

If yes, please specify how long the Q&A session will
be
Expected number of attendees
Confirmed or other invited speakers or panelists
(Please include titles):

Composition of audience (e.g. examiners,
academics, business executives, federal
employees, think tanks, policy makers, lobbyists,
etc.)

Is the media expected to be in attendance?
- Select -

If yes, which media outlets will be in the audience?
Is the event open to the public?
- Select -

Proposed agenda (If agenda for this year is
unavailable, please provide agenda or link to the
agenda for the same event in prior years.)

Will the presentation be recorded or made public?
- Select -

Will the presentation be webcast?
- Select -

Has the organizer solicited the participation of
NCUA employees in other events within the last 3
years?
- Select -

5. Event Organizer Contact Information

First Name
Last Name
Title
Organization
Address Line 1
Address Line 2
Requestor City
Requestor State
- Select -

Requestor ZIP
Requestor Telephone
Requestor Cell Phone
Requestor Email
Requester Confirm Email

Privacy Notice
The information you provide will be used to manage the NCUA's participation at events. The NCUA securely maintains all personally identifiable informatio
shares it outside of the NCUA if required by law or regulation. For additional information, please contact privacy@ncua.gov.

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