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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:
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a public event
a private event (members only)
a class
other
Event/course name:
Anticipated audience size:
Description of event/course:
Are there any specific topics you would like us to address?
Can we publish information about your program?
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Yes
No
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?
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Yes
No
If so, briefly describe:
Will the class be informed in advance of the topic(s) of the speaking engagement?
--
Yes
No