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President's Speaking Engagement Request Form

* Starred questions must be answered at the time of application. All remaining information must be provided to the President's Office no later than 3 weeks before the event date.

CONTACT INFORMATION

First Name *

Last Name *

Organization *

Email Address *

Phone Number *

PURPOSE OF SPEECH REQUEST

Event Name *

Event Description *

Please explain why you are requesting that the President speak *

If the President is unavailable, could another person speak on their behalf? *

Background information about event and/or organization *

EVENT LOGISTICS

Date of Event *

Year

Month

Day

Alternative Date

Year

Month

Day

If a date for the event has not been set, please specify the range of dates

Event time range

Event Location *

Event agenda

Audience Size

Audience Composition

Total length of speaking program

Will your setup allow for PowerPoint or Video presentations? *

Requested length of speech? *

Sponsorship Information

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx pptx.

Suggested speaking points (if applicable)

'DAY OF EVENT' CONTACT (IF DIFFERENT FROM ABOVE)

Contact's Name

Contact's Phone Number *

Contact's Email Address *