Speaker Request Form

Please complete and submit this form to request the NCUA's participation as your upcoming event.

Indicates required field

Section 1: Contact Information

Format: 555-555-5555
Format: http://example.com

Section 2: Event Information

Event Address
Event Format
Primary Event Sponsor/Host
How long has the event been in existence?
Format: http://example.com
Other regulator's invited?

If you selected “yes”, please provide the names of the regulators attending.

Section 3: About the Audience

Target Audience
Check all that apply.

Section 4: About the NCUA's Requested Participation

Has an NCUA employee ever spoken at your event?

If you answered "Yes" above, please provide name(s) and dates(s) below.

Have you contacted an NCUA representative about your event?

If you answered "Yes" above, please provide the representative name(s).

Are you requesting a specific NCUA representative?

If you answered "Yes" above, please provide the representative name(s).

Is the time slot fixed or tentative?
Will you provide the NCUA with the audience's feedback?
Will there be a Q&A?
Will the questions be vetted?
Are materials needed?

Section 5: Media and Event Access

Are media representatives invited?
Is the event open to the public?
Will the event be recorded, broadcast, or streamed?
Format: http://example.com
Is it an audio stream or broadcast?
Is it a video stream or broadcast?
Will there be a photographer onsite for the event?
If you answered "Yes" above, is there a photo approval/release form?

Terms and Conditions for Requesting a Speaker from the NCUA

  1. Submission of this Speaker Request Form is a request only, and does not imply consent to participate by the National Credit Union Administration. The NCUA will consider each request to determine speaker availability and whether participation is in compliance with the laws, rules, regulations and guidelines governing activities of a federal agency and its employees. If the NCUA agrees to participate in the event, confirmation of its participation will be communicated in writing to the contacts provided.

  2. The NCUA must review and approve in advance any public announcement, news release, invitation, promotional material or other information to be released regarding an appearance by its employees at the event. The Requester may not use the name of the NCUA in any way that constitutes or implies endorsement of the Requester, the Requester’s Organization, the event, or any participant or topic connected to the event, by the NCUA or its employees.

  3. All press participation must be approved at least two weeks prior to the event by the NCUA. If you indicate in the Speaker Request Form that the event is not open to the press and subsequently open the event to the press, the NCUA reserves the right to cancel its participation in the event.

  4. The Requester will inform the NCUA if it intends to record or broadcast NCUA employees, or reproduce or distribute any presentations or program material used by NCUA employees in connection with a speech or public appearance.

  5. The Requester agrees to cooperate with the NCUA with regard to security arrangements at the event that may be required by the agency.

  6. Employees of the NCUA may not accept compensation (including a gift or honorarium) or reimbursement for travel or lodging expenses in connection with this event.

  7. The Requester understands and agrees that any material change to the information provided on the Speaker Request Form or any failure to comply with these Terms and Conditions may result in the cancellation of participation in the event by the NCUA and its employees. The NCUA reserves the right to  cancel its participation in the event.

Either party may terminate this Agreement, for any reason or for no reason, upon not less than 45 days prior written notice to the other party delivered in accordance with Section 11.01 stating such party’s intention to terminate this Agreement.

Privacy Notice

NCUA securely maintains all personally identifiable information provided through the Speaker Request Form and only shares it outside of NCUA if required by law or regulation. For additional information, please contact privacy@ncua.gov.