Executive Council Local Conference Request Form

Executive Council Conference Request Form

Section 1 - Contact Information

Name(Required)

First Last

Title(Required)

State Association (include divisions)(Required)

Email(Required)

Enter Email Confirm Email

Phone(Required)

Will you be the primary contact for the Executive Council member during the event. (If you choose No, please enter the name and contact information for the person who will be the primary contact in the fields that appear.)(Required)

Yes

Alternate Primary Contact Name(Required)

First Last

Alternate Primary Contact Email(Required)

Enter Email Confirm Email

Alternate Primary Contact Phone(Required)

Section 2 - Executive Council Member Request

Which Executive Council member would you like to request for the event?

Section 3 - Event Details

Event Name(Required)

Event Location (City, hotel, venue)(Required)

Event Start Date(Required)

Event Start Time(Required)

Event End Date(Required)

Event End Time(Required)

Event Type(Required)

What is the dress code for the event?(Required)

Section 4 - Executive Council Member Responsibilities

What would you like the officer to do while attending the event? (Check all that apply)(Required)

Work with State Officers

Present a Workshop

Bring Greetings

Other

Include any details the officer will need to know in order to prepare including topic, length, links to virtual meeting space, etc. (please describe below)(Required)

Do you give permission for the officer to take photos and/or videos at the event that can be posted to our social media accounts?(Required)

Yes

Section 5 - Financial Obligation

Consent(Required)

I agree that our State Association will be responsible for all travel expenses of the requested Executive Council member.

According to the Policy & Procedures Manual, all expenses incurred while traveling at the request of a State Association shall be reimbursed by the State making the request. Please check the box below.

Section 6 - Conclusion

Is there anything else that traveling officer or BPA staff should know about the event?(Required)