Speaker Information:

First Name

Last Name

Personal Cell for official use only in the event of weather delays/cancellations.

(###)

###

####

Email Address

Exec/ Alternate POC Name

First Name

Last Name

Exec/ Alternate POC Email

Exec/ Alternate POC Phone

(###)

###

####

Please check any and all course materials you plan to utilize:

Slide Deck

Printed Handouts

Flip Charts

Other

Please specify "Other":

Accommodation Information

For those authorized travel via contract, government approval is required (Flatter, Inc. will execute this). Estimates that change MUST be coordinated and approved by Flatter, Inc. and the government prior to travel to the Bolger Center. Once the form is filled out, Flatter will make your hotel accommodations and prepare your Travel Authorization for approval.

Arrival Date/Time at Bolger:

Departure Date/Time from Bolger:

Number of lodging nights required:

If lodging is not required, please indicate if you plan to join us for a meal (breakfast, lunch, or dinner):

If "other" please explain:

Please list any special accommodations:

Where are you traveling from? (City, State)

Airfare Estimate and Departure Airport

if applicable

Rental Car (at Airport) Estimate

if applicable

Taxi, Uber, etc. Estimate

if applicable

Parking at Airport

if applicable

Personal Vehicle Mileage To Airport From Home (one-way)

if applicable

Please provide details regarding your speaking engagement for

the Air Force Civilian Leadership Course 25A

AFCLC 25A Speaker Registration

Please provide details regarding your speaking engagement for

the Air Force Civilian Leadership Course 25A