The University Seminars Guest Speaker Form

ANNUAL DINNER - GUEST SPEAKER FORM
The information you provide will be used to:
- Create event materials including:
  - Invitations
  - Public event web pages
  - News releases
  - Promotional content
- Plan event logistics:
  - Compile dinner guest list for speaker
  - Set up audio/visual equipment based on speaker's needs
- Obtain required permissions for event recordings
Guest Speaker Information
Full Name*

First NameLast Name
Title*
Affiliation*
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Brief Biography (150 words or less)*

0/155
Guest Speaker Dietary restrictions
PhoneEmailAlternate Contact Person
Alternate Contact Information
Please provide an alternate contact person, email, and phone we can use in case we are unable to reach you at your primary contact.
Alternate Contact Person
Alternate Email
example@example.com
Alternate Number
Format: (000) 000-0000.
Alternate Contact Notes
Event Schedule and Lecture Information
Guest speakers should prepare a 45-minute or less talk/lecture. A 15-minute Q & A session will follow the talk.

The Annual Dinner estimated schedule is as follows:
- Guest Speaker Arrival Time: 5:00 - 5:30 PM
- Cocktail Hour: 5:30 - 6:30 PM
- Dinner Begins At: 6:30 PM
- Award Presentation: 7:30 PM
- Guest Speaker Introduction: 7:50 PM
- Talk/Lecture: 8 - 8:45 PM
- Q & A: 8:45 - 9:00 or 9:15 PM
- Event Ends: 9:30 PM
Lecture Title*
Abstract (200 words or less)*

0/205
Uploads and Consent
Guest Speaker Photo (at least 300 dpi, image should look crisp in a 5″ × 7″ print; file size 3.5 MB max.)

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Optional: Any additional graphic elements to use in publicity materials, such as a book cover or image related to the topic (at least 300 dpi, image should look crisp in a 5″ × 7″ print; file size 3.5 MB max.)

Cancelof
Photo Credits (if any)
Supply any weblinks that you would like us to consult and/or use in publicity
Do you consent to being photographed during the event?*
Do you consent to the event being recorded?*
Do you consent to live streaming or interaction via Zoom?*
Accessibility and Audio/Visual Requirements

A microphone and podium are provided at each event.
List any Accessibility Requirements

AV Needs (check all that apply)

Rows	Check all that apply
Laptop
Projector
Sound System
Internet
Video Projection
None

Other A/V Notes or Questions
Speaker's Guest List

Speaker's Guest List for Dinner *

Rows	Prefix	Guest First Name	Guest Last Name	Guest Email	Plus One	Prefix	Plus One First Name	Plus One Last Name	Plus One Email
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Transportation Information
Note any transportation needs (e.g. car service with pickup and drop-off locations and times)*
Other notes or questions
Should be Empty:

ANNUAL DINNER - GUEST SPEAKER FORM

Guest Speaker Information

Alternate Contact Information

Event Schedule and Lecture Information

Uploads and Consent

Accessibility and Audio/Visual Requirements

Speaker's Guest List

Transportation Information