Please complete the form below

Speaker Information

Prefix

Mr.

Ms.

Dr.

First Name

Middle Initial

Last Name

Presentation Slides

I will advance my own slides

Flatter will advance my slides for me on my cue

I will not have slides for my presentation

Microphone Preference

Lapel

Handheld

Name for Nametag

Agency/Organization

Office Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Office Phone

(###)

###

####

Personal Cell, for use only for weather delay/cancellation to contact attendee directly

(###)

###

####

Email Address

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 Airlie. Once the form is filled out, Flatter will make your hotel accommodations and prepare your Travel Authorization for approval.

Arrival Date/Time

Departure Date/Time

Number of lodging nights

Airfare Estimate (if applicable)

Rental Car Estimate (if applicable)

Taxi, Uber, etc. Estimate (if applicable)

Parking at Airport (if applicable)

Mileage To Airport From Home (one-way)

Please list any dietary restrictions and/or special needs:

AFCLC_22B Faculty (Contract) Registration

Please complete the form below