Scheduling Request Form

Host Organization Contact

2. Name of Host Organization: *
3. Please describe your organization: *

   500 characters or fewer please

4. Host Organization Web Address:
5. Host Contact Name: *
6. Host Contact Address 1: *
7. Host Contact Address 2:
8. Host Contact City: *
9. State: * [ -- select -- ] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
10. ZIP Code: *
12. Host Contact Email: *
13. Daytime Phone: *

Presentation Information

1. Type of Organization: * [ -- please select -- ] Academic – Graduate Academic – Primary Academic – Professional Academic – Secondary (High School) Academic – Undergraduate Advocacy Business / Labor / Agricultural Charitable Civic / Local Diaspora Faith Based / Religious Legal Media Other (please describe in notes section below) Retired Think Tank / Research World Affairs / Foreign Relations
2. Notes:

   Please elaborate if “Other” selected above

3. Topic of Presentation: *
4. Audience and Key Participants: * [ -- please select -- ] Student – Professional Studies Student – Graduate Studies Student – Undergraduate Students Student – Other Community Members Elected Officials Business Leaders Educators Philanthropists Other (please describe in notes section below)
5. Notes:

   Please elaborate if “Other” selected above

6. Audience Size: * [ -- please select -- ] 10 – 50 50 – 100 100 – 150 150 – 200 250 – 300 350 – 400 400+
7. Travel Expenses Covered? * [ -- please select -- ] yes no partial

Logistical Information

1. Event Title: *

   Maximum 150 characters please

2. Please include the specific date of your preference for the event. We do not accept open invitations.

   Event Date: *
3. Event Time: *
4. Event Location: *

   Name of building, maximum 150 characters please

5. Event Address 1: *
6. Event Address 2:
7. Event City: *
8. State: * [ -- select -- ] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
9. ZIP Code: *
10. Type of Event: * [ -- please select -- ] Meeting / Conference Lecture / Briefing Breakfast / Luncheon / Dinner Reception
11. Type of Presentation: * [ -- please select -- ] Welcoming Remarks (3 to 5 minutes) Speech (15 to 20 minutes) Short Remarks (5 to 10 minutes) Address (20 minutes or more) Panel Discussion (please list other invited panelists in section below)
12. Other Invited Speakers:

    Please list if Panel Discussion selected above

13. Will media be present? *   Yes No

Speaker Invitation and Event Agenda

1. Event Agenda Document: *

   Max filesize: 2MB. Accepted formats: .doc, .docx, .jpg, .pdf, .ppt. .rtf, .txt, .xls

2. Formal Invitation Letter:

   Optional: If you wish, please upload the formal letter inviting President Clinton to speak at your event.
   Max filesize: 2MB. Accepted formats: .doc, .docx, .jpg, .pdf, .ppt. .rtf, .txt, .xls

3. Please enter the characters in the image below: *

   

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