Speaker Request Form 2015
If you are looking to bring a speaker to campus, the Speakers Committee of the Activities Board would love to help. Please submit this Speaker Request Form at least four academic weeks before the actual event. The form should be as detailed as possible (read: no round numbers in the budget).
Name *
Your answer
Organization
Your answer
Cell Phone Number *
Your answer
Your answer
Have you, or another individual involved attended a Host-A-Speaker training workshop through Student Activities? *
Step One: The Speaker
Requested Speaker *
Your answer
Please briefly describe the speaker you wish to bring to campus (profession, background, etc.) and what type of event you wish to hold (lecture, workshop, round-table discussion, panel, debate, etc.). *
Your answer
Please briefly describe what you feel the speaker would contribute to the Middlebury College community. *
Your answer
Step 2: The Venue
On what date do you plan to have the event?
MM
/
DD
/
YYYY
What space have you reserved for the event? *
To reserve a space contact Tammy Grant at ext. 3147 or go/reserve
Your answer
How many people do you expect to attend? *
Your answer
What other steps have you already taken in preparation for bringing this speaker on campus?
Your answer
Step Three: The Budget
Honorarium *
Your answer
Airfare/Transportation *
Your answer
Hotel Accomodations *
Your answer
Food/Refreshments *
Your answer
Advertising *
We expect a portion of your itemized budget to be set aside for marketing/publicity for your event. Please think of creative ways to advertise your show- posters and social media events work well, as do emails to various groups around campus who would enjoy the event. You can either design posters yourself, or hire Reprographics to design and print color posters. For design questions, head over to go/reprographics or send an email to reprographics@middlebury.edu. Allow at least one week for printing. 11X17 inch posters are $1.00/each; 8.5X11 inch posters are $0.50/each. If granted funding by the Speakers Committee, you must include “Funded by the Activities Board Speakers Committee” on all promotional material.
Your answer
Other
Your answer
TOTAL *
Your answer
We encourage you to seek funding from other organizations on campus in addition to the Activities Board. Please list other sources here (i.e. Campus Organizations, Co-Sponsorships, Commons Offices, Academic Departments, etc.) *
If you are not sure, please contact the co-sponsors
Your answer
Amount Requested from Other Sources *
Your answer
Additional Comments
Your answer
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