Public Events Submission Form

Event Information

Public Event Name/Title: *

Brief Description of Event: *

Presenter's Name: Dr.   Mr.   Ms.   Mrs.    *

Presenter's Title and Affiliation: *

Event Date: *             Event Time: *

Event Location : *

Building: *             Room Number : *

Street Address : *

Are reservations required?  Yes    No

If YES, number to call for reservations:

Phone Number to Call for More Information :

Web Address to Visit for More Information :

Parking Information:

Sponsor(s):

Contact Person : *             Phone: *

Contact Person's Email: *