The University Seminars Guest Speaker Form

ANNUAL DINNER - AWARDEE FORM
The information you provide will be used to:
- Create event materials including:
  - Invitations
  - Public event web pages
  - News releases
  - Promotional content
- Compile dinner guest list for awardee
- Obtain required permissions for event recordings
Awardee 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
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
The awardee will be invited to make a 5-10 minute acceptance speech.

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

Cancelof
Photo Credits (if any)
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?*
List any Accessibility Requirements
Awardee's Guest List

Speaker's Guest List for Dinner *

Rows	Guest First Name	Guest Last Name	Guest Email	Plus One	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 - AWARDEE FORM

Awardee Information

Alternate Contact Information

Event Schedule and Lecture Information

Uploads and Consent

Awardee's Guest List

Transportation Information