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West Chester University Speech Request Form for Dr. Laurie Bernotsky, President

Please email Sabrina Rightmer to confirm the president is available for your event BEFORE submitting your speech request. Please email Jamie Klein if you have questions about this form or would like to contact the speechwriter directly.

To assist in the preparation of remarks, please complete this form and click the Submit button at the end of the form. The form will be sent to Jamie Klein. Thank you.

Contact Information

Please make sure you have filled in all required fields with valid information.

Request Submitted By:

Email:

Phone:

- Phone (next 3 digits): - Phone (last 4 digits):

Is the contact person for the event the same as above?

Yes

Contact Person for event if different from above:

Contact Email:

Contact Phone:

- Phone (next 3 digits): - Phone (last 4 digits):

Event Information

Please make sure you have filled in all required fields with valid information.

Name of the Event:

Event Date, Time, and Location:

Type of Event (e.g., committee meeting, conference opening session):

Purpose of the Event:

Physical Arrangements for the Speaker (e.g., lectern, conference table, head table):

Sponsor(s) for the Event:

Purpose / Goal of the Speaker's Remarks (e.g., welcome guests, give keynote, introduce special guest, bring congratulations, highlight program success):

Length of Speaker's Remarks (approximate minutes):

Approximate Size of Audience:

Composition of the Audience:

Public Figures Expected to be in Attendance:

Person Introducing the Speaker:

Speech Information

Please make sure you have filled in all required fields with valid information.

Key Points to Include in the Speaker's Remarks:

Other facts the speaker should know about the group, occasion, and/or expectations for the remarks:

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West Chester University Speech Request Form for Dr. Laurie Bernotsky, President