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To request a NASA speaker, please fill out the request form below and provide as much information as possible about the event. Note: This form can not be used to request an astronaut appearance. View more information on astronaut appearances.

* Indicates a required field. If not applicable, enter N/A.
Contact information of person requesting a speaker:
*	First Name:
*	Last Name:
*	Organization:
*	Primary Phone Number:				Ext.:
	Alternate Phone:				Ext.:
*	E-Mail Address:
*	Country:		Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor T Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Metropolitan French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island & Mcdonald Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Israel Italy Jamaica Japan Jersey Channel Islands Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Lao People'S Democratic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia, Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Moldova, Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Romania Russia Russian Federation Rwanda Sahara Saint Helena Saint Kitts And Nevis Saint Lucia Saint Pierre And Miquelon Saint Vincent Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Virgin Islands Wallis And Futuna Islands Yemen Yugoslavia Zaire Zambia Zimbabwe
*	Address:
*	City:			*	State:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY	*	Zip Code:
			City, State, and Zip Code are only required if the country is United States

Event Name and Address:
*	Event Name:
*	Organization Hosting Event:
	Organization Website:
*	Type/Background of Organization:
*	Event Sponsor:
*	Dining Table Sponsor:
*	Event Date:   (mm/dd/yyyy)

If multiple dates or flexible dates, please enter one date here and provide details in the comments at the bottom of this form.
*	Event Start Time: (hh:mm)		AM PM   (local time to the event)
*	Speaker Start Time: (hh:mm)		AM PM   (local time to the event)
	Event address same as contact address
*	Event Country:		Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor T Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Metropolitan French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island & Mcdonald Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Israel Italy Jamaica Japan Jersey Channel Islands Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Lao People'S Democratic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia, Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Moldova, Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Romania Russia Russian Federation Rwanda Sahara Saint Helena Saint Kitts And Nevis Saint Lucia Saint Pierre And Miquelon Saint Vincent Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Virgin Islands Wallis And Futuna Islands Yemen Yugoslavia Zaire Zambia Zimbabwe
*	Event Address:
*	Event City:			*	State:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY	*	Zip Code:
			City, State, and Zip Code are only required if the country is United States
	Building or Room:

Other Event Information:
	Event Scope:   International Local National Other Regional					Presentation Type:	Demonstration Keynote Other Panel Presentation/Remarks with Q& A
*	Delivery Method:		In Person Either Virtual/Online
	Purpose of Event:
	History of Event: (number of times held, past speakers, etc...)
	Topic Requested (if known):
	Speaker Requested (if known):
This form should NOT be used to request an Astronaut. Go to Request Astronaut Appearance.
*	Expected Audience Size:			(numbers only)
*	Audience Description:
	Number of Presentations:
	Total Time Allotted (in minutes):					Q&A included?	Yes No
	Confirmation Requested By: (mm/dd/yyyy)
	Justification for expediting processing. If applicable:
	Other Scheduled Speakers:

	Event Open to the Press?			Yes No			If yes, please provide details:
	Event to be Broadcast?			Yes No			If yes, please provide details:
	Speech to be Taped?			Yes No
	Speaker bio needed?			Yes No
	Speaker photo needed?			Yes No

Indicate Equipment Available
	Lavaliere or Lapel Microphone	LCD Projector	DVD Player	Room can be darkened
	Public Address System	Computer with Presentation Software	VCR

Any other information that may help to clarify your request:

You may attach 2 documents to this request (event agenda, event description, etc.). Only PDF file Format accepted:
First Document Name:
First Document location:
Second Document Name:
Second Document location:

	I agree that no person for reason of race, color, sex, religion or national origin, will be excluded from or segregated within membership in sponsoring organization, attendance at event or any of the facilities housing this event.

	Is this event or any part of the event a fundraiser? (YES/NO)      Yes No
	If 'YES', is attendance at the event tax-deductible? (YES/NO)    Yes No