Astros Speaker Series

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Country *

Organization Type *

State/Province

Please fill out any missing organization information below.

Organization Name *

Tax ID * If you know the Tax ID it will speed up the processing and verification of your request.

Zip/Postal Code *

Is there a different name, DBA or chapter?

Year Established

National Taxonomy of Exempt Entities (NTEE) Code *

Mission Statement *

Org Contact First Name *

Last Name *

Title with the Organization *

Organization Address *

City *

State/Province *

Primary Organization Email *

Primary Organization Phone *

Website *

Principal Individuals and Board Members *

The person completing this form who wishes to receive email updates should be entered here

Prefix *

First Name *

Last Name *

Email Address *

Primary Phone *

Cell/Other Phone

Title/Relationship to Organization *

Event/Program Name *

Short Description *

Event Start Date *

Event End Date for Multiday Events (optional)

Event Location and Address of Event * (include Street, City, State and Postal Code)

Number of Guests *

Age Range of Guests *

Appearance Details

Dress Code

Business Formal Business Casual Casual

What will the representative be doing *

Event Budget
Do you have a budget for this event? If yes, please specify amount, otherwise enter N/A. * (Please include if it is a paid or unpaid appearance. If paid, include the appearance fee)

Event Times and Length * (Please include start time and appearance end time. Standard appearance time limited to ONE hour in length)

Event Address *

City *

State/Province *

Zip *

Attachment (optional): Add any additional files that may be helpful for this request

for example Event flyer if nothing specified (Click on Upload File button to attach multiple documents. The files should be selected from a folder on your computer. The files will be listed under the attachment box. Files will be uploaded when you click submit. Attachments must be in one (1) of the following formats: Pdf, doc, docx, xls, xlsx. Limit the file size to less than 10MB.)

Comments

I confirm that I am 14 years or older

* Denotes required fields

This form will expire after 2 hours.

A DonationXchange account will be created and provided in the confirmation email for tracking purposes.

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Astros Speaker Series

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