Speech and Appearance Request

Complete and submit the form below to request a speech or appearance from President Robert O. Kelley.
To fill out a form that can be submitted via mail complete the Printable Form.

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* Required Fields

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Event Date *		Event Time *
Name of Event *		Sponsored/Hosted by
Point of contact for event *		Point of contact's phone *
Point of contact's email *
Audience for event
Location of event *		Room
Location Address		Location phone *
		Expected attendance
		Open to public? *
Media Expected? *
Are remarks requested? *	Yes No
Welcome remarks (3-5 minutes) Short remarks (5-10 minutes) Additional time for Q&A Speech (15-20 minutes) Major address (20+ minutes) Other
Event MC		Who introduces the President?
Will written invitations be issued? * (If Yes, please send a draft or sample)	Yes No
Will there be a podium? *	Yes No	TechNology/AV Equipment (If Yes, please list)	Yes No
Is the President expected to introduce anyone? *	Yes No	If Yes, Who?
Will awards be presented? *	Yes No	Who will present the awards?
To whom will they be presented?
Order of speakers
Other dignitaries attending the event
Issues important to your organization/suggested topics for the President to address
Additional Information
A page stating "Thanks for submitting a request form" will appear when the form has been submitted correctly.