Please fill in the information to your best ability. We highly encourage that requests are submitted at least 6 weeks in advance. If you have questions prior to submitting the form, you can send an email to firstname.lastname@example.org. Contact InformationContact person* First Last Email* Phone*Event InformationDate of event* Date Format: MM slash DD slash YYYY Event start time* : HH MM AM PM Event end time* : HH MM AM PM Name of event*Event description*Please provide event details and describe how the president's role will enhance it.Select the President's role at the event*SpeakerPanel DiscussionEvent AttendeeIf you selected "Speaker", please select a speaking role: Brief/welcome remarks (less than 5 minutes) Moderate speaking role (5-10 minutes) Major speaking role/keynote (more than 10 minutes) Please include an estimated start and end time for the requested role, in the event the president cannot attend the entire event:*Sponsoring organization*Event location* Building Name and Room # Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Estimated number of attendeesAdditional InformationContact person at event location* First Last Phone for on-site contact*Attire Business Professional Business Casual Casual Formal Any other important details?Please also include any parking and audience information.PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.