West Point Speaker Request Form

Organization Name

Event

Date

Time

Location

Subject/Topic

Length

Audience Size

Age Group

Is the speaker’s spouse invited?

  Yes     No

Is this event used for fund-raising?

  Yes     No

If “Yes,” please attach a statement of endorsement
from your local United Way committee chairman.

Will meals, transportation, and lodging
be provided or expenses reimbursed, if applicable?

  Yes     No

Is this event open to everyone
regardless of sex, race, creed, color, or national origin?

  Yes     No

Is this event accessible to the handicapped?

  Yes     No

Answers to the above questions will have a material effect
on whether the Academy can support the event.

For coordination, the speaker may contact (please print):

Full name

Address

City

State

Zip

Phone

Fax

I certify that the information provided is true, complete, and accurate to the best of my knowledge. I further understand that approval of this request depends upon the availability of a volunteer speaker.

SEND TO:
Public Affairs Office
ATTN.: Ms. Debra DeGraw
Community Relations Branch
United States Military Academy
West Point, NY 10996-1788
 
Fax: 845-446-5820
Phone: 845-928-3614