This form is designed to help coordinate speeches and appearances by University of West Florida President Judy Bense. You may submit the form online below, or you can print it out and return it via fax to (850) 474-3131. Due to President Bense’s busy schedule, please submit your request as soon as possible prior to the event. For more information, contact the Office of the President at (850) 474-2200.

Please keep in mind that the president’s schedule is subject to change at any time in the event of emergencies or important developments in university business. If such situations affect the president’s attendance at your event, a member of the president’s staff will contact you, and when possible send an alternate representative. In the event of agenda or timing changes, please notify the Office of the President immediately.

To complete the request form online, please provide the information requested below and click “Submit.” There is no need to fax the form if it is submitted online.

PLEASE NOTE THAT SUBMISSION OF THE SPEAKER REQUEST FORM IS NOT CONFIRMATION OF DR. BENSE’S PARTICIPATION AT THE REQUESTED EVENT. Once your request is submitted/received, you will receive a response from the President’s Office within three business days.

Name of Event: *required

Sponsoring Organization: *required

Date and Time: *required

Contact Person: *required

Office Phone: *required

Cell Phone:

E-mail:

Mailing Address:

Fax:

President’s Arrival Time: *required

Departure Time: *required

Event Location: *required

Event Address: *required

Event Location Phone: *required

If your event is not in Pensacola, please provide directions:

Estimated drive time from UWF: *required

Dress/Attire: *required Business Casual Formal (Black Tie) Other (please specify below)

Number of Guests Expected:

Role of President Attendance Only Speaker

Are remarks requested? Welcoming Remarks (3 to 5 minutes) Speech (15 to 20 minutes) Short Remarks (5 to 10 minutes) Address (20 minutes or more)

Topics President Bense Should Address:

Key Talking Points (please provide 3 to 4 bullet items) : *required

Who will introduce President Bense at the event?

Event/Organization Web Site:

Organization Background/History:

Printed program available? Yes No

List of other activities participants will attend that day:

Details of the event:

VIPs or Legislators in attendance: *required Yes No If so, who? (please list below)

Will there be other speakers? Yes No If so, who? (please list below)

Are press/media expected to attend the event? Yes No

If for any reason President Bense is unable to speak on the requested date, will you accept an alternate speaker from the University of West Florida? Yes No

Any other important details:

Checklist: Please fax the Office of the President at (850) 474-3131 or e-mail presidentsoffice@uwf.edu the following information as soon as possible: Speaker Request Form [either submit online above or print out and fax to (850) 474-3131] An event agenda (working agendas are acceptable; however, please forward the final version as soon as it becomes available) Any press release produced by your event organizers Suggested talking points, background information or speech guidelines Scripts or teleprompter information, if necessary

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