Group or individuals making request
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Your Full Name
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First Name
Last Name
Job Title
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Phone Number
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Format: (000) 000-0000.
E-mail
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Confirmation Email
example@example.com
I would like to:
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Schedule a meeting with Dr. Katie Jenner
Request Dr. Jenner speak or present at an event
Purpose of Meeting (Please describe the topic you would like to discuss.)
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Who is your audience?
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Teachers
Parents
Students
Higher education
Business and industry
Philanthropy
Local/state government representatives
Other
Audience size
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What are you requesting (remarks in-person, virtual remarks, panel discussion, pre-recorded greeting)?
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Meeting Time Frame (Please Select One)
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I would like to request a specific time frame.
At Dr. Jenner’s earliest convenience.
What topic are you requesting for Dr. Jenner to speak about?
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What is the agenda/run of show?
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How long are you requesting Dr. Jenner speak?
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Anything else we should know?
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At what specific time would you like to meet?
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Ex: I would like to meet the week of Dec.12.
Others in attendance
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Location of Meeting
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Please enter full address, or indicate that you can come to Dr. Jenner’s office.
Please specify parking, building entrance and room number details if applicable
I would like Dr. Jenner to be a
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Guest
Honoree
Keynote Speaker
Speaker/Panelist
Other
Date and Time of Event
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Month
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Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Event
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Venu Name
Street Address
City
Please Select
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Texas
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State
Zip Code
Description of Event, including Dr. Jenner’s role/purpose.
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Attach the agenda here.
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Audience
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Please include a description of attendees, who Dr. Jenner will be addressing and the expected number of attendees.
Will press/media be present at this event? If so, in what capacity?
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Ex: School tour from 10:30-11:00 Speaking from 11:00am-11:15 Lunch from 11:30-12:30.
Please specify parking, building entrance and room number details.
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Ex: Park in the west parking lot, enter through door 3, proceed to main office and prep in room A7.
Other Details
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