Group or individual(s) making request:
Date:Please enter date
Location: (include address, building, room number, and entrance)
Length of speech:
Topic of speech:
Who will be in attendance? (include special guests):
How many attendees are expected:
Will there be a microphone?
Will there be a podium?
Will media or press be involved?
What is the dress?:
Please provide an agenda or schedule: