Presidential Engagement Request Form

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Thank you for your interest in having President Helene D. Gayle attend your event. In an effort to effectively manage requests, we ask that event organizers complete the form below.

Email *

Name *

Email Address *

Phone Number *

Hosting Organization and Event Title *

Date and time of event (please include start and end times, as well as the time zone) *

Location of event (please include software platform if event is virtual) *

Objective and brief background of event *

Anticipated audience profile (please include size and demographics) *

Describe the nature of the President's role *

Welcome Remarks (3 - 5 minutes)

Brief Remarks (5 - 10 minutes)

Panel Discussion

Keynote Address

Break-out Session

Plenary

Moderator

Video recording

Other:

What commitment of time is being requested of the President (including pre-event meetings/calls, tech check, the event itself, post-event activities)? *

The times requested for the President's participation should be as exact as possible, as she is often committed to multiple events throughout the day. **Any changes to your event schedule should be communicated to the President’s Office immediately to determine if the change can be accommodated.**

If requesting substantive remarks, what topic(s) will be discussed? *

Names and titles of other speakers or panel participants *

Is the event open to the public, or will access be limited? *

Open to the Public

Limited Access

Is the event open to the media? *

Yes

Will the event be recorded? *

Yes

If there are any promotional materials for the event, please include here. *

Please include amount of honorarium being offered, if any. *

Please provide any other pertinent information the President should have in reviewing your request. *

PLEASE NOTE

In addition to the above information, the following should also be provided:

* If the President’s name/image/likeness is noted on invitation or material for an event, drafts must be submitted for review and approval prior to printing.

* Order of program/run of show due three business days prior to event.

A copy of your responses will be emailed to the address you provided.

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