Event/Meeting Request Form

Contact Information

1. Name**
2. Phone (business)**
3. Phone (mobile)
4. Email**

Event/Meeting Information

1. Name of event/meeting
2. Event/Meeting date
   (MM/DD/YYYY)
   
   
3. Type of event/meeting (please make a selection) Please select Internal External Breakfast Luncheon Dinner Reception Gala Panel discussion Other
   If other, please specify:
4. Purpose of event/meeting
   
5. Sponsoring Organization, Unit or College
6. Attire Please select Black Tie Business Attire Casual N/A
7. Location (address)
8. Event starts at 1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 5:00 5:30 6:00 6:30 7:00 7:30 8:00 8:30 9:00 9:30 10:00 10:30 11:00 11:30 12:00 12:30 a.m. p.m.
9. Event ends at 1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 5:00 5:30 6:00 6:30 7:00 7:30 8:00 8:30 9:00 9:30 10:00 10:30 11:00 11:30 12:00 12:30 a.m. p.m.
10. Invited guests
    
11. Please list all speakers for your event
    
12. Audience composition (please check all that apply)
    
    1. Students
    2. Faculty
    3. Staff
    4. Alumni
    5. Business Leaders
    6. Community Members
    7. Members of your organization only
    8. Elected officials (please list)
    9. Distinguished Guests (please list)

President's Role

1. 1. Speaker - welcome remarks (3-5 minutes)
   2. Speaker - brief remarks (less than 15 minutes)
   3. Speaker - keynote address (15 minutes or more)
   4. Panel participant
   5. Interview or Q & A
   6. Attendee only
   7. Other (please specify)
2. Purpose for President's participation (Please provide specifics on accomplishments, milestones, or success stories the President could inlcude in remarks, as they relate to the event or its purpose and/or agenda.