UNT Health President Request Form

If you would like to request the president’s attendance at an event, participation in a panel discussion, or delivery of a keynote speech, you’ve come to the right place! Filling out this form will provide critical information for our team regarding your request. Due to the volume of requests we receive and time needed to plan, please submit no later than one month prior to your event. Questions? We’re happy to help. Please contact us at president@unthealth.edu.

URL

This field is for validation purposes and should be left unchanged.

Speaker Requested(Required)

Speaker Request Type(Required)

Speaker Type Description(Required)

If "other" was chosen please describe the speaker requests type needed.

Attendance Type(Required)

Attendance Type Description(Required)

If "other" was chosen please describe the attendance request type.

Would you be willing to accept a surrogate speaker if the one you have requested is unable to participate?(Required)

Name of Inviting Organization or Individual(Required)

Organization Description(Required)

Organization Website

Event Name(Required)

Type of Event(Required)

Will there be additional events?(Required)

If there will be additional events, please add the details below.(Required)

Will this event have an honorarium?(Required)

Wardrobe/Event Attire(Required)

Attire(Required)

If "Other" was chosen, please describe the attire for the event.

Event Start(Required)

Event End(Required)

Proposed Event Time(Required)

Event Description(Required)

Speaking Date(Required)

Speaking Date Flexible(Required)

Event Time Zone(Required)

Is the speaking start time flexible?(Required)

Speaking Duration(Required)

Q&A Duration(Required)

Proposed Speaking Topic(s)(Required)

Speaking Topic Details

Event Venue(Required)

If the event is virtual, please enter "n/a" for event location fields

Event Location Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please list the street address of where the event will take place

Are you expecting any distinguished guests at this event?(Required)

Are any other HSC members speaking at this event?(Required)

Please provide the names of any registered lobbyists who will be in attendance(Required)

What types of media are invited to the event?(Required)

Broadcast

Print and/or Web

Local

Regional

National

Live Webcast

Media Not Invited

Audience Size(Required)

Audience Composition & Proportions(Required)

Event Contact Name(Required)

First Last

Event Contact Title(Required)

Event Contact Email(Required)

Event Contact Phone(Required)

Bio Attachment

Drop files here or

Max. file size: 22 MB.

Is the inviting organization registered as a lobbyist?(Required)

Is the inviting organization a 501(c)(3)?(Required)

Is there a fundraising component to this event?(Required)

Event Itinerary (Attachments)

Max. file size: 22 MB.

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UNT Health President Request Form

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UNT Health President Request Form

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