Speaking Remarks Request Form
Speaking Remarks Request Form
Fields denoted by an asterisk (
*
) are required.
Your Contact Information
Name:
Name:
*
First
Last
Department:
*
Phone Number:
Phone Number:
*
-
###
-
###
####
Extension:
Email:
*
Event Details
Name of Event:
*
Primary Objective:
*
Event Date:
Event Date:
*
/
MM
/
DD
YYYY
Event Venue:
*
Speech Setting (ie: Stage, Podium and Microphone, Casual):
*
Speaker's Arrival Time: (hh:mm a.m. / p.m.)
Speaker's Arrival Time: (hh:mm a.m. / p.m.)
*
:
HH
MM
AM
PM
AM/PM
Start time of the remarks at the event:
Start time of the remarks at the event:
*
:
HH
MM
AM
PM
AM/PM
Proposed Agenda, including list AND ORDER of other speakers:
*
Audience Composition and Size:
*
Is this an annual event:
*
Is this an annual event:
Yes
No
Is this an alumni or donor relations event:
*
Is this an alumni or donor relations event:
Yes
No
Are there any individuals who should be recognized:
*
Are there any individuals who should be recognized:
Yes
No
If yes, please provide names and titles:
*
Speaking Requirements
Purpose of Speech:
*
Expected Length of Remarks or Speech:
*
2 minutes or less
2-5 minutes
5-10 minutes
Who will introduce the Speaker (Name and title):
*
Key messages you would like delivered:
*
Logistics
Parking Arrangements:
*
Dress Code:
*
Who will greet the Speaker?
Name:
Name:
*
First
Last
Cellphone Number:
Cellphone Number:
*
-
###
-
###
####
Email:
*
Who will support the Speaker at the event?
Name:
Name:
*
First
Last
Cellphone Number:
Cellphone Number:
*
-
###
-
###
####
Email:
*
Background
Other important background information about event that should be mentioned:
*