CEO Speaker Request

This form is designed for internal use to submit requests for Byron Garrett’s participation in speaking engagements and key events. Collecting consistent information helps ensure alignment with organizational priorities, supports thoughtful planning, and promotes effective stewardship of the CEO’s time in service of our mission.

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Organization Account ID

GW User ID

GW Location

Length of Speaking Time Requested:

Please provide the time in hours. Use decimal places to indicate partial hours. (i.e. 1.5 = an hour and a half).

Requestor Information

Organization Name:

Start typing the name of your organization to find the correct one. If you do not see your organization, please just type the name in.

Name:

Start typing your name. If you do not see your name, please reach out to the Genesys Works Technology Team.

First Name:

Last Name:

Department:

Title:

Work E-Mail Address:

Phone Number:

Event Overview

Event Name:

Event Description:

Date of Event:

Time of Event:

Event Format:

VirtualIn-Person

Location of Event (City/State)

CEO Participation Details

Requested Role for CEO:

Length of Speaking Time Requested:

Proposed Topic(s):

Target Audience:

Anticipated Audience Size:

Will there be other speakers?

YesNoUnsure

Please list other confirmed speakers and titles:

Additional Details

Have the MarComm & Development Team been informed of this event?

YesNo

Will any notable attendees be present (e.g. major donors, elected officials, board members, etc.)?

YesNo

If yes, please list name and title:

By submitting this form, I understand that completion does not guarantee the CEO's availability or participation. All requests will be reviewed by the Office of the CEO.

I acknowledge and agree

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Contact Information