Ted Mitchell Speaking Engagement Request Step 1 of 5 20% Please provide the following information regarding the details of the speaking engagement request.Host InformationHost Organization Name(Required)Primary Contact InformationName(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Suffix Title(Required)Organization Name(Required)Phone Number(Required)Email Address(Required) Event InformationEvent Title(Required)Event Sponsor (if applicable)Event Date(Required) MM slash DD slash YYYY Event Venue(Required)Venue Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Session Length(Required)Start Time(Required) Hours : Minutes AM PM AM/PM End Time(Required) Hours : Minutes AM PM AM/PM Number of People in the Audience(Required)Please enter a number greater than or equal to 1.Audience Composition(Required)Session Format(Required) Roundtable Session Plenary Session Concurrent Session Board Meeting Other Event Dress Code(Required) Business Business Casual Semi-Formal Formal Name of Individual Introducing the President(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Suffix Title of Individual Introducing the President(Required)Organization Name for Individual Introducing the President(Required) President's RoleWhat is the specific role of the President?(Required) Keynote Address Introductory Remarks Moderator Panelist Attendance Only Time allotted for remarks (in minutes)Please enter a number from 1 to 600.Time allotted for Q&A (in minutes)Please enter a number from 1 to 600.Who will be seated with the President?Will media be present?(Required) Yes No List the media outlets that will be in attendance(Required)List the themes or topics you would like the President to address(Required)List other key CONFIRMED participants for this eventList other key UNCONFIRMED participants for this eventIf the President is unable to attend, please list a surrogate from the Council Audio/Visual Contact (if available)Name First Last CompanyPhoneEmail Additional Questions or CommentsIf you have any additional questions or comments, enter them below:Privacy PolicyPlease take a moment to review our privacy policy. Terms of Use Agreement(Required) I have read and fully understand the extent of the American Council on Education’s privacy policy. PhoneThis field is for validation purposes and should be left unchanged.
