Presentation Request Form

Presentation Request Form

Contact Information

Name:  Today's date:
Phone:  Email:
Name of organization/department:

Engagement details

Date requested:  Time:   Location:
Is your request for:  Program Length:
Event/course name:  Anticipated audience size:
Description of event/course:
Are there any specific topics you would like us to address?
Does anyone attending the event need special accommodations?
Can we publish information about your program?

For classroom presentations

If this is a classroom presentation, please answer the following:
Will related material be covered in this class prior to the speaking engagement?
If so, briefly describe:
Will the class be informed in advance of the topic(s) of the speaking engagement?