Function Representative Request

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Please consult the Standards Manual for protocol regarding the Board.

If any changes are made to the program within 48 hours of the event, please notify Lynn Leskow.

Submit this form to request an EIPS representative attend your event.

School or Organization Requesting the Representative *

Email *

Address of Event

Type of Event

Date of Event

Time of Event

Start Time and End Time

Dress Code

Approx. # of Attendees

List other non-EIPS dignitaries attending the event

Is anyone invited being asked to speak at this event

If YES, please provide details below.

Yes

No

Who is requested to speak

Type/Theme of Remarks

Length of Remarks

Additional Info

Please provide any additional background information that may be useful in preparing remarks for the speaker(s).

Attach a copy of the program

Choose File No file chosen

Coordinator/Contact Person

Coordinator/Contact Phone #

The representative will be met by

Phone #

Leave Blank