Question: Please Select the Type of Appearance You’re Requesting
Note: The type of appearance you’re requesting will help us gather the correct information to best service your request
Selection: Virtual
Note: An appearance conducted virtually through the internet, video, or phone
Selection: In Person
Note: An appearance at a specific location inside or outside the United States
Acknowledgement: I understand I will e responsible for all expenses incurred to support this appearance (e.g., travel, accommodations, etc.)
Selection: Recorded Greeting
Note: A pre-recorded audio or video greeting/segment delivered to your organization
Question: Please Tell Us About Yourself
Note: We need to know who is making the request and who is sponsoring the appearance. Please fill out all the contact information below. AO to provide definitions of the requestor/sponsor for clarification to the user.
Field: Salutation
Field: First Name
Field: Last Name
Field: Middle Initial
Field: Title
Field: Organization
Field: Email Address
Field: Work Phone
Field: Cell Phone
Field: Home Phone
Field: Address 1
Field: Address 2
Field: City
Field: Country
Field: Postal ZIP Code
Field: Salutation
Field: First Name
Field: Last Name
Field: Middle Initial
Field: Title
Field: Organization
Field: Email Address
Field: Work Phone
Field: Cell Phone
Field: Home Phone
Field: Address 1
Field: Address 2
Field: City
Field: Country
Field: Postal ZIP Code
Field: Salutation
Field: First Name
Field: Last Name
Field: Middle Initial
Field: Title
Field: Organization
Field: Email Address
Field: Work Phone
Field: Cell Phone
Field: Home Phone
Field: Address 1
Field: Address 2
Field: City
Field: Country
Field: Postal ZIP Code
Question: Please tell us about the details for the appearance you are requesting. The more specific the information you can provide us, the better we can process your request.
Field: Title for Appearance
Note: Type a short title for this appearance. We’ll reference this title in any future correspondence.
Field: Start Date
Field: End Date
Field: Drop Dead Date
Field: Are your dates tentative?
Field: Comments about the event
Note: Please enter any comments you feel are useful for us to know about the event and/or your needs.
Field: City
Field: Country
Field: Postal ZIP Code
Section: Topic And Audience
Question: Tell us about any special topics you would like the speaker to discuss, as well as the type of audience and audience size.
Field: Topic(s) Requested
Note: Enter any special topics you would like discussed. This helps our astronauts prepare for your event
Field: Target Audience
Note: Example: Engineers, Academia, Medical School aged, etc…
Field: Audience Size
Note: Approximate number of audience members
Field: Organization Type
Field: Web Site
Note: URL of your organization’s website
Field: Fundraising (Boolean yes/no)
Field: Fundraising Comments
Section: Astronaut(s) Requested
Description: Indicate how many astronauts you are requesting, any specific astronaut(s) you would like to request, and any background traits you feel will make the appearance successful. Please note that due to scheduling and mission constraints any specific astronaut you request may be unavailable. Also note that only active NASA astronauts are available for named astronaut selection.
Field: Number of Astronauts Requested
Selection: I’ll take any astronaut
Selection: I’d like to request a specific astronaut(s)
Selection: I’d like to request a specific astronaut(s) but will take any if unavailable
Field: Astronaut has flown missions (Boolean yes/no)
Field: Military Branch Background
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | DEIBEL, TIMOTHY A. (JSC-CD2)[CIMARRON] |
File Modified | 0000-00-00 |
File Created | 2022-07-14 |