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Part 1 : Event Organizer
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Name of Organization Submitting Request :
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Event Sponsor(s) :
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Coordinator/Point of Contact Name :
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Email :
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Phone Number :
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Part 2 : Event Details
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Event Name/Title :
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Event Location :
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Event Date :
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Event Time :
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Event Type :
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Other Event Commitments :
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Part 3 : Presentation/Speech Details
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Requested Topic :
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Presentation Format :
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Expected Time Duration :
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Will There Be Audience Questions/Answers :
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Part 4 : Audience Details
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Audience Size :
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Media Attendance :
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Will Dr. Turner Lee's be Expected to Engage in Any Interviews? :
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Part 5 : Additional Information
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Will Dr. Turner Lee Be Required To Pay A Registration Fee?:
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Is There Travel Assistance :
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Is There An Honorarium and If So, How Much? :
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Will Dr. Turner Lee Be Asked To Sign A Disclaimer or NDA as Part of Her Participation?
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