Chairmen Appearance Request Form

Thank you for your interest in a speaking appearance. We appreciate requests made at least 8 weeks in advance. We will attempt to respond to your request in a timely manner, within four weeks from date of submission. For further information, please call 202-463-5856.


Today's Date:

I am requesting an appearance by the:
Chair of the Board Vice Chair Regional Vice Chair
Other (please specify):

Company/Org. Name:

Current U.S. Chamber Member? Yes No

My organization is a:
Chamber Association Company
Other (please specify):

Is your organization:
Accredited? (chambers only) Number of stars (About chamber accreditation) A Federation Partner? (chambers & associations only) (About Federation Membership)

Your Contact Person:

Contact Phone:		Ext.

Contact Fax:

Contact Email:
Your Web site URL:

Date and Time of Event:

Is This a Recurring Event?		No Annual Quarterly Monthly
Other (please specify):

Location of Event:

Approximate travel time to nearest airport?


Name of Event:

Type of participation requested:		Speech Keynote Panelist Q&A
Other (please specify):

Length of remarks requested: (if applicable)

Topic or particular issue to address:

Will this event be open to the media? Yes No

How many people are expected to attend?

Advancing human progress through an economic, political and social system based on individual freedom, incentive, initiative, opportunity, and responsibility.