Request to Address the Campus Community

FORM INSTRUCTIONS: Complete this request a minimum of 5 days in advance of your event by completing the form below. This form is submitted online to the Director of Conferencing and Scheduling to process. Once your date has been checked for availability and approved, you will be sent an e-mail confirmation. Allow up to five business days. Fields noted by a red asterisk (*) are required.

Name*
First Last
Organization Name
Current Mailing Address*
Street Address Address Line 2 City State ZIP Code
Telephone Number*
Cell Phone Number
Email*
Requested date to be on campus*
MM slash DD slash YYYY
Alternate date*
MM slash DD slash YYYY
Alternate date*
MM slash DD slash YYYY
Requested time to be on campus*
From

: Hours

Minutes

AM/PM
To*
To

: Hours

Minutes

AM/PM
Brief description of information to be presented in the public forum*
Location you would like to address the campus community (only one area will be approved)*
- Jefferson Square Lawn
- Campus Walk in the front of James Farmer Hall
- Palmieri Plaza outside of Monroe Hall
Pledge*
I agree to abide by the laws of the Commonwealth of Virginia and the rules and the regulations of the University of Mary Washington, and to follow the instructions of the University of Mary Washington Office of Events and Conferencing.

I agree that I will not enter any building or venue anywhere on campus without the express permission of the Office of Events and Conferencing.

I agree that I will be on campus during the requested times and dates approved.

I will not be involved in any form of solicitation.

I will not distribute food or beverage to the community, as well as, I will not sell any items while addressing the campus community.

I will see that the area designated is free of litter, literature, or any other materials that have resulted from my presentation and participation.

I will make sure no unauthorized fliers or stickers are posted or left behind on campus. I will not post or display signs on any trees on campus.

I agree tenting is prohibited.
I agree
Electronic Signature*
Date*
MM slash DD slash YYYY

Addressing the Campus Community

Request to Address the Campus Community

Events and Conferencing

UMW Events