Speaker Request Form: New Era Of Smarter Food Safety

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Food and Drug Administration US FDA

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New Era of Smarter Food Safety Speaker Request Form 
SPEAKER REQUEST FORM ­ NEW ERA OF SMARTER FOOD SAFETY
Thank you for your interest in inviting an FDA Representative to participate in your event. To better assist us in processing your request, please provide as much information as possible in the form below and return it to SmarterFood Safety@fda.hhs.gov. We will respond to you as quickly as possible upon receipt of the information below.

Name of event Host/organizer/sponsor Preferred date & time Location Purpose/theme Requested name of speaker (if any) Other FDA employees invited to speak at event Moderator of the event and/or individual introducing the FDA Speaker
Event registration fee and/or fee range for attendees

EVENT DETAILS

Attach/provide draft agenda (if available)

Proposed role for speaker (e.g., keynote, session speaker, panelist, Q/A):

FORMAT DETAILS

Duration of session/remarks/Q/A

1

Approximate number of attendees
Audience profile (e.g., government, industry, growers, international, consumers)

AUDIENCE

Open or closed to media (If open to press, please provide a POC)
Webcast
Video recorded

MEDIA

Requested topic/areas of discussion

CONTENT DETAILS

2
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