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AlumniSpeaker

RequestFor
m
T
or equestanalumnispeaker
,pl
eas
ec ompl
eteandsubmi
tthi
sfor
mt ot
heUCSDAl
umniAssoc
ia-
t
ionVolunteerManager
.Pleas
esendthefor
mt oPri
ceCenterThirdFl
oorAl
umniAff
air
sorf ax
i
tto( 858)534-8976.

Ev
entTi
tl
e: Ev
entDat
e: Ev
entTi
me:
Ev
entDes
cri
pti
on:

Deadl
i
net
oRec
eiv
eSpeak
er(
s)by
:

Coor
dinat
or’
sCont
actI
nfor
mat
ion:
Name: Or
gani
zat
ionName:
PhoneNumber
: E-
Mai
l
:

SpeakerRequestI
nfor
mat
ion:
Numberofs
peak
ersr
eques
ting:
Wi
llyouneed:Abi
ogr
aphyoft
hes
peak
er(
s)?Y N Aphot
ooft
hes
peak
er(
s)?Y N
Speak
erAr
ri
valTi
me: Speak
erDepar
tur
eTi
me:
How l
ongwi
l
lal
umnis
peak
? Wi
l
lyouar
rangef
orpar
kingf
ort
hes
peak
er?Y N

Pleasedes
cribeanys peci
fi
cdetail
sy ouwoul
dli
keinanAlumniSpeak er
(s).F
orexample,s
peaker
shouldbefrom as peci
fi
cc ol
l
ege,campusorgani
zat
ion,pr
ofes
sion/
industr
y,car
eerst
age(ent
ry
l
ev el
,seni
orlevelexecuti
ve,etc
),gradyears
.

Pleas
egi veabri
efdes
cri
pti
onoftherol
eofthespeaker
,hi
s/herr
esponsi
bil
i
tiesont
hedayoft
he
event,andthethemeofthespeaker
’ss
peec
h.Ifthi
sisakeynoteaddressorapanelpl
eas
estat
e
thesedetail
sher
e:

Submi
mtt
edby
: Dat
e:

Pr
iceCent
erEas
t,9500Gi
l
manDr
ive-
0083,L
aJol
l
a,CA92093-
0083,(
858)534-
3900,(
866)UCSD-
ALUM,F
AX(
858)534-
8976

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