<?xml version="1.0"?>
<xml>
      <title>EMD Speaker Request Form</title>
<keywords>web publishing,web site content management software,web content management system,web cms,xml content management tool,knowledge management system software,internet intranet extranet portal software,elearning content management</keywords>
<description/>
      <meta content="text/xml;" http-equiv="Content-Type"/>
<main-content>
   <meta content="en-us"/>
<meta content="Microsoft FrontPage 6.0" name="GENERATOR"/>
<meta content="FrontPage.Editor.Document" name="ProgId"/><form action="../../../speaker.asp" language="JavaScript" method="post" name="[object]" onsubmit="return FrontPage_Form1_Validator(this)">
<table border="1" bordercolor="#111111" cellpadding="0" cellspacing="0" class="osmall" id="AutoNumber1" style="border-collapse: collapse; border-width: 0px;" summary="table" width="100%">
<tbody>
<tr>
<td colspan="2" style="border-style: none; border-width: medium;" width="100%">
<p class="top">EMD Speaker Request Form:</p>
</td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" width="31%">&#160;</td>
<td style="border-style: none; border-width: medium;" width="69%">&#160;</td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" width="31%"><span>Name of Organization:</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Organization" size="49" tabindex="1"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" width="31%"><span>Location:</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Location" size="49" tabindex="2"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" width="31%"><span>Date:</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Date" size="14" tabindex="2"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" width="31%"><span>Time:</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Time" size="14" tabindex="3"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" width="31%"><span>Presentation Length (time):</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Lenght" tabindex="4"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" width="31%"><span>Number of Persons Attending:</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Persons" size="6" tabindex="4"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" width="31%"><span>Topic Requested:</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Topic" size="50" tabindex="4"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" width="31%">&#160;</td>
<td style="border-style: none; border-width: medium;" width="69%">&#160;</td>
</tr>
<tr>
<td colspan="2" style="border-style: none; border-width: medium;" width="100%"><strong><span>Do you have audio visual equipment available for the speaker to use, if needed?</span></strong></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" width="31%">&#160;</td>
<td style="border-style: none; border-width: medium;" width="69%">&#160;</td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" width="31%">&#160;</td>
<td style="border-style: none; border-width: medium;" width="69%">
<table border="0" class="osmall" id="table1" summary="table" width="100%">
<tbody>
<tr>
<td width="209">Computer</td>
<td><span style="font-family: Arial;"><input name="Computer" tabindex="5" type="radio" value="Yes"/></span><span>YES&#160;</span> <span style="font-family: Arial;"><input name="Computer" tabindex="6" type="radio" value="No"/></span><span>NO</span></td>
</tr>
<tr>
<td width="209">Projector with Computer Input</td>
<td><span style="font-family: Arial;"><input name="Projector" tabindex="7" type="radio" value="Yes"/></span><span>YES&#160;</span> <span style="font-family: Arial;"><input name="Projector" tabindex="8" type="radio" value="No"/></span><span>NO</span></td>
</tr>
<tr>
<td width="209">Screen</td>
<td><span style="font-family: Arial;"><input name="Screen" tabindex="9" type="radio" value="Yes"/></span><span>YES&#160;</span> <span style="font-family: Arial;"><input name="Screen" tabindex="10" type="radio" value="No"/></span><span>NO</span></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" valign="top" width="31%"><strong><span>Contact Information:</span></strong></td>
<td style="border-style: none; border-width: medium;" width="69%">&#160;</td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" valign="top" width="31%"><span>Name:</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Name" size="35" tabindex="11"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" valign="top" width="31%"><span>Address:</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Address" size="59" tabindex="12"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" valign="top" width="31%">
<p align="right"><span>City:</span></p>
</td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="City" size="24" tabindex="13"/></span> <span>State:</span> <span style="color: #000080; font-family: Arial;"><!--webbot bot="Validation" b-value-required="TRUE" --><input name="State" size="4" tabindex="14"/></span> <span>Zip</span><span style="color: #000080; font-family: Arial;">: <!--webbot bot="Validation" b-value-required="TRUE" --><input name="Zip" size="8" style="width: 82px; height: 22px;" tabindex="15"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" valign="top" width="31%">&#160;</td>
<td style="border-style: none; border-width: medium;" width="69%">&#160;</td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" valign="top" width="31%"><span>Email:</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Email" size="36" tabindex="16"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" valign="top" width="31%"><span>Phone (daytime):</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Phone" size="23" tabindex="17"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" valign="top" width="31%"><span>Other Phone (please specify):</span></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="color: #000080; font-family: Arial;">&#160;<!--webbot bot="Validation" b-value-required="TRUE" --><input name="Alt_Phone" size="23" tabindex="18"/></span></td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" valign="top" width="31%">&#160;</td>
<td style="border-style: none; border-width: medium;" width="69%">&#160;</td>
</tr>
<tr>
<td style="border-style: none; border-width: medium;" valign="top" width="31%"><strong><span>Comments:</span></strong></td>
<td style="border-style: none; border-width: medium;" width="69%"><span style="font-family: Arial;">&#160;<textarea cols="42" name="Comments" rows="8" tabindex="19"></textarea></span></td>
</tr>
</tbody>
</table>
<p align="center"><span style="font-family: Arial;"><input name="B1" style="font-weight: bold; color: #000080;" type="submit" value="Submit Query"/><input name="B2" style="font-weight: bold; color: #000080;" type="reset" value="Reset"/></span></p>
</form>
</main-content>
<copyright>
   
</copyright>
</xml>
