Items marked with * are required.
Please note that ILA cannot guarantee a speaker for your event.
Name of ILA Affiliate
Speaker Requested: 1
Speaker’s Primary Role at Event
Speaker’s Primary Presentation Topic
Event Title / Type
Event Location (City/State)
Year ILA Last Provided a Speaker
Your E-mail Address
Your Phone Number
Speaker Requested: 2
Speaker Requested: 3rd Choice
By checking this box, I confirm that I and my ILA Affiliate have read, understand, and agree to the following:
ILA cannot guarantee a speaker for your event
. When considering speaker requests, ILA must weight many factors, including (but not limited to) speaker availability, the amount of time since ILA last sent a speaker to a location or event, the general purpose of the trip, and the cost of travel.
If providing a speaker, ILA will cover the expense of airfare; however, any and all onsite expenses (ground transport, hotel, registration, meals, etc.) must be arranged and paid for by the council/affiliate. In addition,
some Board members may request the council/affiliate pay ALL their travel-related expenses, including airfare.
All sections of this form, except where noted, must be completed for ILA to process the request.
Contact Christina Marconi at