Speech/Appearance Request
Robbyn Wacker, Acting Provost & Senior Vice President

Name of Event:

Contact Person:

Phone:

Address:

E-Mail:

Description of Event:

</p> <p> <label>Date of Event:</label> <input type="text" name="Date_of_Event" size="21" maxlength="20"/> </p> <p> <label>Time of Day:</label> <input type="text" name="Time_of_Day" size="21" maxlength="20"/> </p> <p> <label>Place:</label> <input type="text" name="Place" size="51" maxlength="50"/> </p> <p> <label>Sponsoring Organization:</label> <input type="text" name="Sponsor" size="46" maxlength="45"/> </p> <p> <label>Are Remarks Requested?</label> </p> <p> <input name="Remarks_Requested" type="radio" value="Yes" /> <label>Yes</label> <input name="Remarks_Requested" type="radio" value="No" checked="checked" /> <label>No</label> </p> <p>What Remarks are Requested?</p> <ul> <li> <input name="Remarks[]" type="checkbox" value="Welcoming Remarks (3-5 minutes)" /> <label>Welcoming Remarks (3-5 minutes)</label> </li> <li> <input name="Remarks[]" type="checkbox" value="Speech (15-20 minutes)" /> <label>Speech (15-20 minutes)</label> </li> <li> <input name="Remarks[]" type="checkbox" value="Attend only (Reception)" /> <label>Attend only (Reception)</label> </li> <li> <input name="Remarks[]" type="checkbox" value="Attend only (Dinner/Banquet)" /> <label>Attend only (Dinner/Banquet)</label> </li> <li> <input name="Remarks[]" type="checkbox" value="Short Remarks (5-10 minutes)" /> <label>Short Remarks (5-10 minutes)</label> </li> <li> <input name="Remarks[]" type="checkbox" value="Major Address (20 minutes+)" /> <label>Major Address (20 minutes+)</label> </li> <li> <input name="Remarks[]" type="checkbox" value="Additional Time for Q&A" /> <label>Additional Time for Q&A</label> </li> </ul> <p> <label>Suggest Topic of Remarks:</label> </p> <p> <textarea name="Topic_of_Remarks" rows="3" cols="50">

Will there be other speakers? If so, who and in what order will they speak?

Number of persons estimated to be in attendance:

VIP's in audience:

Press/Media Expected to Attend:

Audio/Video Available
(tall podium & mic generally preferred):

Special Notes:

Written Invitations Issued?

Yes No

If yes - Please send copy