Speaking Requests

* = required fields

Your Contact Information

• Name: *
• Salutation: *
• Department: *
• Phone Number: *
• Email: *

Event Details

• Name of Event: *
• Primary Objective: *
• Event Date: (mm/dd/yyyy) *
• Event Venue: *
• Speech Setting (ie: Stage, Podium and Microphone, Casual): *
• President's Arrival Time: (hh:mm a.m. / p.m.) *
• Proposed Agenda, including list AND ORDER of other speakers *
• Audience Composition and Size *

• If yes, please provide names and titles:

Speaking Requirements

• Purpose of Speech *
• Expected Length of Remarks or Speech *
• Please select one Under 5 Minutes 5-10 Minutes 10-20 Minutes 30 Minutes or More
• Who will introduce the President (Name and title) *
• Individuals to be acknowledged in speech: *
• Key messages you would like the President to deliver: *

Logistics

• Parking Arrangements: *
• Dress Code *

Who will greet the President?

• Name: *
• Cellphone Number: *
• Email:*

Background

• Other important background information about event that should be mentioned: *