Supervisor Susan Ellenberg Speaking Request Form

Meeting Name

Meeting Date

Meeting Time (total)

Meeting Location & Address (Put "virtual" if an online event)

Role for Supervisor Ellenberg

Meeting Purpose/Intention

Meeting Audience Description

Estimated Number of Attendees

Length of Supervisor Speech

What Topics Should the Supervisor Focus On?

Has the Press or Media Been Invited to Attend?

Yes

Agenda/Run of show (Specify whether draft or final)

Parking Information (Put N/A if event is virtual)

Commendation or Certificate Requested?

Meeting Contact Person Name

Meeting Contact Person Phone

Meeting Contact Person Email

Meeting Url or Website

Additional details (format, run of show, other speakers, whether there is a cost for attendees, etc.)

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