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Office of the Provost
Hovde Hall, Room 100
610 Purdue Mall
West Lafayette, IN 47907-2040
(765) 494-0665
Fax: (765) 496-2031

Speech / Appearance Request Form
This form has been designed to help coordinate speeches and appearances by Provost Randy Woodson. You may submit the form online. Please submit your request at least two weeks prior to the event. Should you have questions concerning this material, please contact Becky Franklin at (765) 494-6835. Thank you for your cooperation.

Name of Event:	*required
Contact Person:	*required
E-mail:
Office Phone:	*required
Fax:
Description of Event:
Day & Date of Event:	*required
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, mike; please describe):


Special Notes:



Written invitations issued? Yes No
By whom?


Expenses of event charged to: