Office of the Provost

Speaker Request

To request Provost Martha Pollack as a speaker for your event, you may use this online form. Please submit your request at least four weeks prior to your event. Should you have questions, please contact Sharron Schmidt at 734-764-9292.

* denotes a required field

Name of Event *
Contact Person *
E-Mail *
Office Phone *
Fax
 
Description of Event
Day & Date of Event *
Time of Day *
Location *
Hosts
Phone
Sponsoring Organization *
 
Type of remarks requested Welcoming remarks
Short remarks
Speech
Topic of remarks:
Will there be other speakers? * Yes No
 
Number of persons estimated to be in attendance:
 
Dignitaries in the audience: Yes No
If so, who?
 
Michigan Alumni in audience: Yes No
If so, who?
 
Press/Media expected to attend? * Yes No
Names of media groups represented:
 
Special Notes:
 
Please enter the words exactly as you see below for anti-spam purposes: *
NO SPAM