Request a Speech or Appearance

SPEECH/APPEARANCE REQUEST FORM

This form has been designed to help coordinate speeches and appearances by President France A. Córdova. You may submit the form online, or you can print it out (PDF; requires Adobe Acrobat) and return it via fax, (765) 494-7875, or mail to the President's Office, Purdue University, 610 Purdue Mall, Room 200, West Lafayette, IN 47907-2040. Please submit your request at least 30 days prior to the event. Should you have questions concerning this material, please contact Barbara Cochran at (765) 494-9707. Thank you for your cooperation.

Name of event:	*required
Contact person:	*required
E-mail:
Office phone:	*required
Cell phone:
Fax:
Description of event:
Day & Date of event:	*required
Attire:
Time of day:	*required
Place:	*required
Hosts:
Phone:
Sponsoring organization:	*required


*required Are remarks requested? Yes No
Welcoming remarks (3-5 minutes)	Short remarks (5-10 minutes)
Speech (15-20 minutes)	Major address (20 minutes +)
Topic of remarks:


*required Will there be other speakers? Yes No
If so, who and in what order will they speak?


Number of persons estimated to be in attendance:


Dignitaries in the audience: Yes No
If so, who?


Purdue alumni in audience: Yes No
If so, who?


*required Press/media expected to attend: Yes No
Names of media groups represented:


Audio/Visual available (podium, mic; please describe):


Special notes:



Written invitations issued? Yes No
By whom?


Expenses of event charged to:

If someone in the audience needs accommodations such as a sign language interpreter, please contact the President’s Office at 49-49708 to make special arrangements.

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