Wisconsin Department Of Veterans Affairs

1. What is the event name?

2. What is the organization name?

3. Who would you like to speak

Secretary Deputy Secretary Assistant Deputy Secretary

Women Veterans Coordinator Tribal Veterans Liaison Federal Claims Assistance Wisconsin Veterans Homes

Mental Health & Suicide Prevention Specialist Wisconsin Veterans Cemeteries Wisconsin Military Funeral Honors

4. If requesting the Secretary and he is not available, would you like another representative from the WDVA Office
of the Secretary to speak?

Yes No

5. Event Date(s)

From

To

6. Requested date of Speaker's appearance

From

To

9. What is the organization's website?

10. Organization point of contact name?

11. Organization point of contact e-mail address

12. Organization point of contact phone number

13. What is the event's location?

Please include address if you have one.

14. If this is a speaking engagement, is there a specific topic or focus for the remarks?

15. What is the estimated arrival time for the Speaker?
Choose an appointment time:

16. Will the event be indoors, outdoors, or exclusively online?

Exclusively Online Indoors Outdoors

17. If speaking, what is the allotted speaking time?

18. Would you like WDVA to be present at your event in an additional capacity? (Booth Space, Training, Traveling Exhibit, etc.)

Please check all that apply

Federal Claims Assistance

General Veterans Benefits

Mental Health and Suicide Prevention

Wisconsin Veterans Cemeteries and Military Honors

Wisconsin Veterans Homes

Wisconsin Veterans Museum

Women Veterans Program

19. Please note any special requests

Wisconsin Department of Veterans Affairs