Speaker Request Form - Becker College

To schedule a speaking engagement or request that President Johnson participate in an event or ceremony, please provide the following information via the online form. Please supply as much information as you have at this time and keep us posted if your plans change.

Contact Information for Event Organizer

Name*

FirstLast

Phone*

Fax

Email*

Event Details

Name of event*

Date of event*

Starting time of event*

: HH

MM

Estimated ending time of event*

: HH

MM

Location of event*

Sponsoring organization

Purpose of event*

Dr. Johnson's Role

Attendance Only
Participation

If you checked "Participation":

Describe the exact nature of the role Dr. Johnson is expected to play (check all that apply) and indicate the total length of time you wish him to speak:

If selected "other," please describe:

Length of time requested:

5 minutes or less
5-10 minutes
10-20 minutes
Other

If selected "other," please indicate

Is a podium available?

Yes
No

Is a microphone available?

Yes
No

List the order of speakers or describe the flow of events, indicating the approximate time Dr. Johnson's part in the program begins and ends:

Who will introduce Dr. Johnson?

Is Dr. Johnson free to leave after his remarks?

Yes
No

Should he plan to stay for the entire event, if possible?

Yes
No

Is his wife, Michelle Jones-Johnson, to be included in your invitation for this event?

Yes
No

Please email background materials (e.g., bios, speaker's notes, description of your organization, etc) to patricia.kalinowski@becker.edu.

When available, please send the official invitation to the event, printed program, and confirmed guest list.

Function atmosphere (and dress):*

Business
Casual
Formal (Black Tie)
Other

If selected "other," please describe

Number of attendees expected:*

Nature of audience (check all that apply):*

If selected "other" please describe.

VIPs in audience

Press/media expected to attend:

Speech/Appearance Request

Contact Information for Event Organizer

Event Details

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