Speaker Invitation Form

AUTHORITIES: The information on this form is requested under the authority of 5 U.S.C. 301, 22 U.S.C. §2651(a), 22 U.S.C. §1431, 22 CFR §2451 and Executive Order 13571.

PURPOSE: The purpose of this form is to provide U.S. citizens with the ability to request a U.S. Department of State speakers’ attendance at a local event.

ROUTINE USES: The information on this form will be used to identify a potential U.S. Department of State speaker for the requested event. This information will not be shared outside of the Department of State. More information on the Routine Uses for the system can be found in System of Records Notice, State-22, Records of the Bureau of Public Affairs.

DISCLOSURE: Providing this information is voluntary . Failure to provide the information requested on this form will result in the Department’s inability to fulfill the speaker request.