Target audience: ________________________________ Number of attendees: _________ Conrmation deadline: __________________
Approximately what percentage of the audience will be banks? ____________________________________________________________________
Of the banks attending, approximately what percentage of the banks are supervised by the OCC? _____________________________________
Of the banks attending, what are their asset sizes? Less than 1B 1B to 10B Greater than 10B
Has an OCC employee ever spoken at your event? Yes No if “yes”, please provide name(s) and date(s).
Name: ____________________________________________________________________________________________ Date: _________________
Have you contacted an OCC representative about your event? Yes No if “yes”, please provide name(s).
Are you requesting a speci
c OCC representative? Yes No if “yes”, please provide name(s).
Name: ______________________________________________________ Name: _______________________________________________________
Specic date of the engagement: _______________________ Start time: ________________________ End time: _______________________
Is the time slot xed or tentative? Fixed Tentative
Will you provide the OCC with the audience’s feedback? Yes No
If panel, indicate the moderator’s name and organization. _________________________________________________________________________
If panel, title of the panel? _____________________________________________________________________________________________________
Will there be a q/a? Yes No
If you are requesting the OCC for more than one speaking engagement, please enter the other sessions’ details.
Are materials needed? None Presentation Handouts Both
Are media representatives invited? Yes No (if “yes”, please provide details).
Is the event open to the public? Yes
Will the event be recorded, broadcast, or streamed? Yes No ______________________________________________________
Please provide other relevant or useful information about this event.
Please email the form to OCCOutreach@occ.treas.gov and retain a copy of this form for your records.
In the email, please attach any material related to the event (agenda, yer, etc.).
Section 3: About the Audience
Section 4: About the OCC’s Requested Participation
Section 5: Media and Event Access
If yes, please provide the website to access the recording or streaming.