Speaking Request Form

Thank you for contacting us. In order to best meet your needs, please complete this form to invite Dr. Campo to speak at or attend a meeting or event. As president of Regent University, Dr. Campo wants to accommodate as many requests as possible. However, some invitations may have to be declined due to scheduling conflicts. We appreciate your patience and understanding and invite you to submit other requests for alternate dates.

Event Details

Event Name:
Event Location:
Event Date:	(mm/dd/yyyy)
Alternate Date 1:	(mm/dd/yyyy)
Alternate Date 2:	(mm/dd/yyyy)
Event start time:
Event end time:

Time guests will begin to arrive:
Number of anticipated guests:
Is the audience internal, external, business, education, donors, etc. (please be as specific as possible):
Age range of audience:

Time Dr. Campo requested to arrive:
Time allotted for Dr. Campo's remarks:
Duration of Dr. Campo's presence*:
*NOTE: Please be as exact as possible in the times requested as Dr. Campo is likely to have other engagements on this same date. If your event schedule changes after your invitation has been accepted, please contact Heather Platz at 757.352.4015 or hplatz@regent.edu immediately and she will let you know if the change can be accommodated.

Dress Code:
Is there a theme for this event?
If yes, what is the theme?
History of this event (inaugural, annual, etc.):

Contact Information

Contact Person:
Phone Number:
Address:
Email (one address only):
Name of the person who will meet Dr. Campo at the event: