UW Bothell - Office of the Chancellor - Chancellor's Attendance Request Form

Chancellor's Attendance Request Form

Thank you for your interest in inviting Chancellor Chan to attend your event. Before completing this online form please contact the Office of the Chancellor by phone or e-mail with your invitation at 425.352.5221 or chancellor@uwb.edu.

Following the phone conversation with the Office of the Chancellor please complete this form with as much information as possible and submit immediately.

This form is for internal UW Bothell use only.

Items marked with an " * " are required.

Event Information

Name of Event*

Sponsoring Organization*

Date*

Event Start Time*

Event End Time*

Street Address*

City, State*

Building Name*

Room Name or Number*

Event Details

Purpose of Event*
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Will the media be invited?
Yes
No

Will written invitations be issued?
Yes
No

If so, please forward a copy of the invitation to UW Bothell Office of the Public Relations, 18115 Campus Way NE, Bothell, WA 98011, uprc@uwb.edu or fax at 425.352.3611

Remarks

Remarks are Requested

Welcoming Remarks (3-5 Minutes)
Brief Comments (5-10 Minutes)
Full-length Speech (15-20 Minutes)
Keynote Address (20+ Minutes)

At what time will Chancellor Chan be asked to speak? *

Please list topics will be of interest to the attendees*

Name of person introducing Chancellor Chan*

Please list other speakers or performers*

Please give the size and describe the audience. Include any other special guests.*

Event Materials Event materials are required two weeks in advance of event to the Office of the Chancellor

Suggested talking points for the Chancellor:*

List of Attendees*

Additonal information:*

Contact Information

Contact Person*

Phone*

Email*

Fax*

Onsite Contact Person*

Onsite Contact Phone*