Event Request Form

Thank you for your inquiry into President Rose's availability to speak at your event. Please complete and submit the request form below. We will contact you as soon as possible.

Event Information

Event Name:	Event Date:
Event Time:	Event Location:

Contact Information

Contact Person's Name:	Contact Person's Department:
Contact Person's Email:	Contact Person's Daytime Phone:

Specifics

PLEASE READ BEFORE FILLING NEXT SECTION OUT
When entering the program order, people, or topics please separate each with a comma. If you use the enter button, we will not get the entire list. The fields that you need to do this will be marked below with a ***.

Meal?

Will there be a head table?

If so, who will be seated at the head table? ***

Expected Audience Size:

Length of Speech:

Topics or concerns that should be included: ***

Other Speakers: ***

Order of Program: ***

Are there people in the audience who should be recognized (dignitaries, groups, politicians, donors, etc.)? If so, who? ***

Other Comments: ***

Note: Please forward to this office a list of attendees 2 days before the event.

Office of the President
Attention: Donna Burch
MSC 7608
Alumnae Hall, Room 208
Harrisonburg, VA 22807
Phone: (540) 568-6868
Fax: (540) 568-2338

University Planning

Event Request Form

Event Information

Contact Information

Specifics