Officer / Regional Vice President Visit Form

INSTRUCTIONS/REGISTER

OFFICER / REGIONAL VICE PRESIDENT VISIT REQUEST FORM

Please use this form to request a visit by one of the NAA Officers / Regional Vice Presidents.

If you would like to request a visit by a member of the NAA or NAAEI Staff, please complete the NAA Staff Visit Form.

Officer / Regional Vice President Visit

Please provide information on what you would like accomplished during the visit. If you have a preference for a speaker, please indicate his or her name on the form. Visit the 2008 NAA Board of Directors page to view the complete list. NAA Board Members may be used as speakers for local, state and regional meetings, as well as trade shows and other special events.

Affiliate Name:

Affiliate Address:

City/State/Zip

Contact Name (of person making the request):

Contact Title:

Phone:

Fax:

E-mail:

PROGRAM INFORMATION

Name of Program:

Program Dates:

Program Time(s):

Location:

Major Objective of Program:

Type of Program (cocktail reception, dinner, luncheon, show):

Special Duties to Perform (installation of officers, awards presentation):

Desired Length of Speech:

If you have a preference for a speaker, please indicate here:

The state or local affiliate should absorb the cost of this visit. However, if the state or local affiliate cannot afford the entire cost, it does not preclude the visit.
Affiliate is prepared to pay entire expenses.
Affiliate can pay a certain amount towards visit (if checked, please complete next question)

Amount Affiilate can contribute towards visit:

QUESTIONS? Please contact Karen Goggin at 703/518-6141 Ext. 107.