Request the VICE-PRESIDENT
*required fields in yellow
To make it easier for us to fulfill your request, please provide ALL of the information requested.
Party Making Request:
Email Address:
Phone Number:
Fax Number:
We Invite Vice-President Ben Shelly as our:
-
Guest
Speaker
Keynote Speaker
Honoree
Other
Event Date:
8:00 am
9:00 am
10:00 am
11:00 am
12:00 pm
1:00 pm
2:00 pm
3:00 pm
4:00 pm
5:00 pm
6:00 pm
7:00 pm
8:00 pm
9:00 pm
Time:
Location of event: (include address, building, room number and entrance)
Description of event:
Purpose of Vice-President's Involvement:
Who will be in attendance?
(Include any special guests you have invited, and approximate head count.):
Is press/media involved? In what capacity?:
Speech Details
Topic:
Length of speech:
Yes
No
Will a Podium be provided:
Yes
No
Who will introduce him?:
Who else is speaking/performing?
Please provide the following information:
What is the dress attire:
(An intinerary of the event, driving directions, if applicable,
talking points
about your organization/group/initiative, any other important information):
Will a Microphone be provided:
Security Code:
Please type the characters as you see in the image.(Case insensitive)