Speech / Event Participation Request Form

Event Details

Event Name:
Location:
Date:
Start Time:
What is the Provost's role for this event?
If speaking, what is the preferred length of comments?
What is the presentation set up (podium, mic etc)
Who is the audience?
Please describe any special concerns /issues/areas of interest that the group would like to hear addressed.
Please list (if any) people in the audience who should be recognized (dignitaries from the group, politicians, donors etc.)

Contact person's information

Name:
Phone
Email

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