All of the following information should be submitted as accurately and completely as possible no less than 3 weeks prior to the event date.

For questions regarding this form, please contact Barb Chapin at chapi001@umn.edu or 612.626.7386.

Event Name
Your answer
Please select the OED administrator you are requesting for your event.
Requested speaker's Role
Your answer
Event Date
MM
/
DD
/
YYYY
Event Start Time
Time
:
Event End Time
Time
:
Time requested speaker is required to attend
Time
:
For a speaking role, please indicate the type of remarks you are requesting.
This information is required.
Would you like the speaker to participate in a 5-minute Q&A following their remarks?
This information is required.
Will there be a podium available for the speaker?
If you wish the speaker to provide a keynote, a podium must be made available.
For a speaking role, please list 3-4 significant talking points you would like to be covered
This information is required.
Your answer
Location
(name and address)
Your answer
Event Theme
(if applicable)
Your answer
Event Description
Your answer
Event Agenda
If the agenda is not available at the time of request, please email it to chapi001@umn.edu when ready.
Your answer
Main Event Sponsor
Your answer
Event Co-Sponsor(s)
(if applicable)
Your answer
Event Contact Person
Your answer
Event Contact Person - Office Phone
Please use this format: xxx-xxx-xxxx
Your answer
Event Contact Person - Cell Phone
Please use this format: xxx-xxx-xxxx
Your answer
Event Audience
(e.g., students, parents, faculty, community members)
Your answer
Anticipated Number of Attendees
Your answer
Will there be reserved seating for the speaker?
(If so, please give brief explanation of where)
Your answer
Specific Driving Directions
(other than what a GPS would generate)
Your answer
Parking Instructions
Your answer
Please provide any additional information that would be helpful for the speaker to know.
i.e., names of VIPs to meet or greet, special instructions, etc.
Your answer
Please contact Barb Chapin at chapi001@umn.edu or 612.626.7386 at least one week before the event to discuss any changes or provide additional information regarding the event.
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