OSC Seal


U.S. Office of Special Counsel
1730 M Street, N.W., Suite 218
Washington, D.C. 20036-4505

SPEAKER REQUEST FORM 
(FEDERAL AGENCY REQUESTER) 

Please fill out the form below and fax it to Leslie Williamson, at 202-653-5161.  Questions about completing this form should be directed to Leslie Williamson at 202-254-3600 or lwilliamson@osc.gov.

1.  General Event Information 
a. Title and description of event: 





2.  Agency Contact Person For Proposed OSC Presentation: 




 
5. Will payment of speaker's travel-related expenses be offered? (Payment of such expenses is not required for consideration of this request.) If yes, please complete the following: 
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12. Can you have a computer compatible with Microsoft Power-Point and projector available for the presentation?    ()      (
Do you have a microphone or podium?    ()      (
 
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