Office of the Public Liaison and Intergovernmental Affairs

U.S. Department of State Speaker Invitation

Thank you for your interest in featuring a U.S. Department of State speaker at your foreign
policy forum. In order for your invitation to be considered, please supply as many details as
possible in the below form. [Please note that any asterisk(*) indicates a mandatory field.]

This form is not intended for use in extending invitations to the Secretary of State.
In order to do so, please send a formal letter including the event details and contact information
via fax to the following number: (202) 647-1579 or via mail to the following
address: Office of Public Liaison, Room 2206, 2201 C Street NW, Washington, DC 20520

Upon submission of this form, the Office of Public Liaison and Intergovernmental Affairs will
review your invitation to verify if it aligns with the outreach mission of the Office. If so,
a representative will be in touch with you to explore the possibility of providing an appropriate
subject-matter expert to address your foreign policy forum.
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Name and brief description of host organization*:
(maximum of 500 characters)

Host Organization Web Address:

Host Contact Name*:

Host Contact Street Address 1*:

Host Contact Street Address 2:

Host Contact City*:

State*: Zip Code*:

Email Address*:
Daytime Phone*:

Type of Organization*:

Notes:

Topic of Presentation*:
To select multiple, (hit CTL). There is a maximum of three topics. If other, please describe in the notes section:

COUNTRIES AND REGIONAL

ECONOMICS AND ENERGY

ARMS CONTROL AND SECURITY

DEMOCRACY AND GLOBAL AFFAIRS

OTHER (Please describe in notes section below)

Notes:

Audience and Key Participants*:
If other, please describe in the notes section:

Notes:

Audience Size*:

Travel Expenses Covered?:

Event Title*:
(maximum of 150 characters)

Event Date and Time*:
(maximum of 500 characters)

Event Location:(Building name):
(maximum of 150 characters)

Event Street Address 1:

Event Street Address 2:

Event City*: State*:
Zip Code*:

Type of Event*:

Type of Presentation*:

Other Invited Speakers:

Will there be Q&A?*:

Will media be present?*:

Submission Selection*

Special Notes/Instructions:

U.S. Department of State

Diplomacy in Action

U.S. Department of State Speaker Invitation