The President's Office

Request for Speaking Engagements

Want to invite Dr. Jorgenson to your special event?  Just list your group and event name, date, time, location, and the role that you would like Dr. Jorgenson to play in your event below, and the president's staff will contact you within two business days.

Instructions:  This form is best viewed with the Internet Explorer browser. Complete this form in its entirety, then click "Submit" at the bottom of the page.

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Date:   April 20, 2014, 9:28:58 pm 
Information of Person Making Request  
  * First Name:  
  * Last Name:  
 *  Organization Name:  
 * Department/Division/Committee:  
   * Contact Phone:  
In the format of: 555-555-5555  
  ext.  
   * Email Address:  
Engagement Information  
* Name of Engagement:  
* Street Address of Engagement:  
* City of Engagement:  
* State of Engagement:  
* ZIP of Engagement:  
* Country of Engagement:  
* I would like to request:  
  
If Other:  
* What is the date on which  
this engagement is to take place?:  
   
* At what time on this date  
is this engagement to take place?:  
:  
* Engagement Description:  
(be very specific):
  

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Other Comments:  
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Please note:  Submission of this form does not guarantee the president's attendance, but we'll do our very best to add your request to her schedule!  We strongly encourage you to submit your invitations as early as possible.  If you have any questions, please contact Miranda Smith at msmith28@nwacc.edu. Thank you!

For questions/comments on this content, please contact Miranda Smith.

This page was last updated on:  October 17, 2013 @ 11:46 am