Chancellor’s Appearance Request Form Please fill out the form below and we will contact you regarding your request.Event Name Event Location Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry Event Date Event Start Time 010203040506070809101112HH000510152025303540455055MMAMPMAM/PM Event End Time 010203040506070809101112HH000510152025303540455055MMAMPMAM/PM Chancellor Participation Start Time 010203040506070809101112HH000510152025303540455055MMAMPMAM/PM Chancellor Participation End Time 010203040506070809101112HH000510152025303540455055MMAMPMAM/PM What time will most guests arrive? 010203040506070809101112HH000510152025303540455055MMAMPMAM/PM Contact Person Contact Phone Contact Email Number of People Expected Age Range of Guests Dress Code Business ProfessionalBusiness CasualCasualFormal Event Theme Is the Chancellor being requested to speak? YesNo What is the group's interest in hearing the Chancellor speak? Does the group have any special interests or concerns that should be addressed? Is there a topic or subject that should be addressed in the Chancellor's remarks? Should remarks be formal or conversational? FormalConversational Preferred length of comments Are there people in the audience who should be recognized/thanked? If so, who? Are there any other speakers? If so, who? Is there a possibility that other speaker's comments will overlap the Chancellor's remarks? YesNoMaybe