Request to Address the Campus Community

FORM INSTRUCTIONS: Complete this request a minimum of 3 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 at least three 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*
- 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, and I will see that the area designated for the public forum is free of litter, literature, or any other materials that have resulted from my presentation and participation in the public forum.
I agree
Electronic Signature*
Date*
MM slash DD slash YYYY

Request to Address the Campus Community

The Crawley Great Lives Lecture Series

Commencement

Family Weekend

UPCOMING EVENTS