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Speech Requests

This form has been designed to help coordinate speeches and appearances by President William H. Crouch, Jr.. Please submit your requests at least four weeks prior to the event. Direct questions to the President's Office Staff.

All fields are required.

Event Information

1. Name of the Event
2. Type of Engagement speaking consulting
3. Type of Speaking Engagement keynote panel roundtable
4. Date
5. Time
6. Approximate Audience Size
7. Audience Description
8. President's Arrival Time
9. President's Departure Time
10. Event Location
11. Event Address
12. Nature of the Event
13. Dress/Attire
14. Is Mrs. Crouch requested? Yes No
15. Are remarks requested? Yes No
16. Will there be other speakers? Yes No
17. Will there be GC alumni in attendance? Yes No
18. If, for any reason, the President is unable to attend will you accept an alternate speaker from Georgetown College? Yes No

Contact Information

1. Sponsoring Organization
2. Name
3. Position
4. Office Phone
5. Cell Phone
6. Fax
7. E-mail
8. Mailing Address

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