Chancellor's Office

Speech Request

Please enter the details of your speech request below, being as specific as possible. However, if you do not know what to write for the optional values, please leave the fields blank. Required fields are labelled in orange. If you'd prefer to fill out this form by hand, we've provided a printable version of the form in Adobe PDF format.

Event

Event Name:

Please specify if this is a stand-alone event or part of a conference.
Please include or send the entire conference agenda.

Sponsoring Group:

Description of your Organization:

Event/Sponsor Website:

Date(s) of the Event:

Date of David Wilson's apperance:

Speech Overview

Event Start Time:

Event End Time:

Speech Start Time:

Speech End Time:

Topic of the Speech:

Purpose of the Speech:

Last Year's Speaker(s):

Logistics

Number Attending:

Person meeting David Wilson upon arrival:

Location Name:

Location Address:

Designated Parking:

Building Entrance:

Driving Directions (Include Landmarks):

Event Site Phone:

On-site Mobile Phone:

Seating arrangements for David Wilson:

Media Plans:

Contact

Contact name for this event:

Email Address:

Send a copy of this form to this email address

Primary Phone:

Secondary/Mobile Phone:

University of Wisconsin-Extension

University of Wisconsin Colleges

Chancellor's Office

Speech Request