Name of Event  

Event Date   January February March April May June July August September October November December          1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31          2008 2009

Event Time      From 10:00AM 10:30AM 11:00AM 11:30AM 12:00PM 12:30PM 1:00PM 1:30PM 2:00PM 2:30PM 3:00PM 3:30PM 4:00PM  To 10:00AM 10:30AM 11:00AM 11:30AM 12:00PM 12:30PM 1:00PM 1:30PM 2:00PM 2:30PM 3:00PM 3:30PM 4:00PM

Event Location  

Location Address  

Length of time to speak  

Question and Answer Period Yes No

Goal of Event  

Specific Topic for Speaker       

Other Details for Speaker

If applicable, please upload an event flyer or any other pertinent information.

Requesting Organization       

Contact Person  

Contact Phone  

Fax  

Email  

Annual meeting  Staff/Club meeting
Education/Recruitment Fair  
Other

Private meeting
Public Meeting
If your meeting is open to the public, are you doing any press around the event? Please explain:

Men
Women
Men and Women
High School Age
College Age

Number Expected