Presidential Speaking Request

Please use this form to request that Lester A. McCorn, D.Min., President of Paine College, speak at your event.

Date of Request Date of Request / MM / DD YYYY
Department or Organization
Requestor/Point of Contact Requestor/Point of Contact Title First Middle Last Suffix
Phone Phone - ### - ### ####
Email
Date of Event Date of Event / MM / DD YYYY
Start Time Start Time : HH MM AM/PM
End Time End Time : HH MM AM/PM
Requested Time of Arrival Requested Time of Arrival : HH MM AM/PM
Speaking Time Allotted
Academic Regalia Required

Academic Regalia Required Yes No
Dress Attire: If so, dress attire
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Facility being used
Description of Event or Activity
Keynote Welcome Remarks, Other Description of audience

Briefly describe whom & make-up
Suggested points to make in remarks
Question/Comments
Spam Protection. Please answer this simple question:
5, 6, 7, 8 : the 4th number is?