Invite Vice President Burgess to Speak at Your Event

Event Name

Date of Event

Requests should be submitted at least 30 days prior to the planned event.

Start Time

End Time

Location of Event

Type of Request

e.g., keynote speaker, panelist, plenary session speaker, welcome/closing remarks

Approximate Start Time and Length of Speech/Remarks

Expected Size of Audience

Event Attire

e.g., casual, business casual, black tie

Brief Description of Event/Organization

Your Name

Your Email

If Making Request on Someone's Behalf, Please Enter Their Name

Department/Organization

Telephone Number

Street Address

City, State and Zip Code

Comments