Speaker Request Form

DCSA Speaker Invitation Request Form

DCSA is the nation's premier provider of integrated security services and home to diverse specialists and leaders in the security services and DOD enterprise. Agency Leadership and leaders from across our many mission areas are available to engage on wide-ranging topics like personnel vetting, industrial security, counterintelligence, insider threat, security training, IT development and AI, just to name a few.

To request a DCSA Speaker for your upcoming event, please complete this form in its entirety - we cannot process your request until we receive a complete version. If there are fields that do not apply, please type “N/A”. DO NOT LEAVE IT BLANK or it will result in a non-submission. We recommend you submit at least 45 days before the event or we cannot guarantee we will process your invitation in time for a final decision.

After completing this form, please send a current agenda (draft agendas are acceptable) and any other marketing materials or links for your event to the DCSA Office of Communications and Congressional Affairs.

Affiliation with Organization:*
Job Title:*
Phone Number:*
Email Address:*

Email

Confirm

Full Name:*

First

Last

Organization Website*
Event Website:*

Main Speaking Topic Requested:*

Describe Topics and/or Sub-Topics to be Discussed:*

Please be specific. What do you want your audience to walk away knowing?

Will there be a Q&A Session?*

YesNo

If yes, who will moderate? Please hyperlink a bio, or email a copy to dcsa.quantico.hq.mbx.comms@mail.mil

Has DCSA participated in the past?*

YesNo

If yes, please let us know of past participation or other engagements with DCSA.

Describe the primary general audience (Select all that apply): *

NOTE: Use SHIFT or CONTROL to make multiple selections

Number of attendees anticipated (in person or virtually during the live session): *

Select a range.

Names and titles of notable individuals confirmed to attend:

For Example: Members of Congress, Federal Government Leaders, CEOs, other VIPs

Will media/press be in attendance?*

If you anticipate media, please include the media/press list (name and organization). Alternatively, you may email a copy to dcsa.quantico.hq.mbx.comms@mail.mil

A draft list is acceptable, but you must provide the updated list within 15 days of the event to [email].

Will remarks be:*

On the recordOff the record

Will the event be recorded?*

YesNo

If yes, how will the recording be used, and where will it be published/posted?

Will the event be live-streamed?*

YesNo

If yes, what is the intended purpose?

Cost to attendees other than a speaker (please provide the highest value/cost of ticket, value/cost of food, and value/cost of beverages for legal analysis, not sufficient for "No cost to government"). Please do not leave this section blank as it is needed by our legal team to provide a proper assessment. If the amount is $0 please enter that in the fields below:

Value/cost of ticket/registration:*
$
Value/cost of food/beverages:*
$

Specific expenses covered by organizer: *

Memento, travel expenses, meal, invitation to any reception, etc.

Submission of the request form does not authorize the requestor to use the name, title, photograph, or biography of the requested speaker as well as The Defense Counterintelligence and Security Agency in any form of marketing materials. Official written notification of acceptance or decline will be provided to the requestor upon completion of our legal and public affairs vetting process. If you plan to send out a press release or advertise an approved speaker, please coordinate with us for approval before releasing.
Speakers cannot participate in any activity that is associated with fundraising, promotional activities or endorsements, either directly or indirectly.
Speakers may not participate in any activity or event that has partisan political affiliation, pursuant to the Hatch Act of 1939.
Speakers cannot participate in any activity in which any group has been unlawfully segregated or unequally treated on the basis of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability, or genetic information.
Speakers cannot accept honoraria, stipends, or fees for speaking.

Disclaimer*

I agree to the Speaker Guidelines

Need Assistance?

If you have any questions or need help completing the Speakers Invitation Request Form, please e-mail: Office of Communications and Congressional Affairs.

DCSA Speaker Invitation Request Form

DCSA Speaker Invitation Request Form

EVENT INFORMATION

REQUEST A SENIOR LEADER SPEAKER

REQUESTOR CONTACT INFORMATION

AREA OF FOCUS

AUDIENCE

LOGISTICS FOR EVENT

MEDIA

EXPENSES

Guidelines/Disclaimer

Need Assistance?

DCSA Speaker Invitation Request Form

DCSA Speaker Invitation Request Form

EVENT INFORMATION

REQUEST A SENIOR LEADER SPEAKER

REQUESTOR CONTACT INFORMATION

AREA OF FOCUS

AUDIENCE

LOGISTICS FOR EVENT

MEDIA

EXPENSES

Guidelines/Disclaimer

Need Assistance?

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