Thank you for considering the Division of Minority and Women’s Business Development (DMWBD) for participation in your event. Please complete the Event Speaker Request Form and a DMWBD representative will contact you. Please note DMWBD typically requires 30-day advance notice and all requests undergo an internal approval process.

First Name:*

Last Name:*

Email:*

Phone:*

Organization/company:*

Industry:*

Public Non-profit Private

Event Host First Name:*

Event Host Last Name:*

Event Title:*

Event Description:*

Event Date:*

Event Time:*

AM/PM:*

AM PM

Event Format:*

Virtual In-Person
If in-person, please share the full address for the event location:

Estimated number of attendees?*

Please describe the intended audience for the event.*

Who from the DMWBD are you requesting to speak? *

-- Select -- Executive Director/Executive Vice President Senior Management Certification Representative Business Development Representative Unknown or Other Unknown or Other, please provide more detail:

What topic(s) are you requesting to be covered?
(Select all that apply) *

NYS MWBE Certification
NYS Contracting Opportunities
       (How to do Business with NYS)
Access to Capital
Broader Diversity, Equity, and Inclusion
Other
Other, please provide more detail:

What role are you requesting speaker participation?*

-- Select -- Keynote Speaker Moderator Panelist Presenter Remarks Other Other, (please specify):

Is a presentation expected?*
(PowerPoint or other visuals)

Yes No

What is the requested speaking/presentation length for the speaker?*

Will the speaker be required to answer questions from the audience?*

Yes No

Will this event be recorded?*

Yes No

Will media outlets be present at the event?*

Yes No
If Yes, provide details: