* = Required Information
*Name of Event:
(Please be specific)
If any of the following apply, please provide the beginning times for each:
Social (Cocktails and / or Reception):
ROLE PRESIDENT IS TO PLAY (Check One):
If you checked "Participation," Please complete all sections of this request form.
If you checked "Attendance Only," Please complete the sections above only and then go to the bottom of
the form for processing instructions.
1. Please provide a list of other members of the University administration who will be invited to attend.
2. Is President Moulton's wife, Geri, expected to attend?
3. Event Atmosphere (and dress):
Formal (Black Tie)
Other: (Please explain)
4. Number of Guests Expected:
Nature of audience: (Please check all that apply).
Your Organization Members
COMPLETE THE SECTION BELOW ONLY IF PRESIDENT MOULTON IS EXPECTED TO PARTICIPATE IN
THE PROGRAM. UPON RECEIPT OF THIS FORM, YOU WILL BE CONTACTED BY THE SPECIAL EVENTS
COORDINATOR FOR THE PRESIDENT.
1. Describe the exact nature of the role the President is expected to play. Please check all that apply:
Remarks (5 min. or less)
Keynote Address (20 + minutes) a
Interview or Q & A c
Awards Presentation d
Master of Ceremonies e
Topic: (Please be specific)
Please provide names and introductory information.
Please provide information about the interviewer and/or reasons for interview or Q & As.
Please provide names of recipients, information about the award, why the recipient(s)
is receiving the award.
Please provide bios, speaker's notes, description of your organization and other
information as requested.
Please skip questions 2 - 5.
Please provide a copy of the program or meeting agenda one week prior to event.
2. Is a podium available?
Is a microphone available?
3. List the order of speakers or describe the flow of events, indicating the approximate time the President's
part of the program begins and ends.
4. Who will introduce President Moulton?
(We will supply introductory information).
5. Is the President free to leave after his remarks?
Should he plan to stay for the entire event, if possible?
6. If President Moulton is the Master of Ceremonies or Host, please provide:
Printer's Proof of Invitation prior to printing.
Printer's Proof of Program prior to printing.
Guest List. (ASAP or at least one week prior to mailing of invitations).
Drawing of room with seating assignments.
Copy of the printed program.
Please complete the sections above, PRINT and FAX the completed form to (251) 461-1537.