Home Executive Vice President/CEO Appearance & Speaker Request Form Close University of Utah Health Main navigation Department of General About Us Main navigation About U of U Health Calendar Giving Health Sciences Workforce Excellence Newsroom Transforming Health Why Utah? Community Main navigation Our Community Commitment Sundance Sponsorship Education educMain navigation AVP Health Sciences Education Colleges & Schools Patient Care Research Research Research Areas & Initiatives Training & Education Resources Who We Are News Philanthropy U Health Plans Acknowledgement Project Requests Services You must have JavaScript enabled to use this form. * Indicates required field Name of the event * Sponsoring organization or department * Org/Dept Website Org/Dept X link Org/Dept Instagram link Contact person (First and Last Name) * Contact email * Office Phone * Mobile phone * Event start date and time * Event start date and time: Date * Event start date and time: Time * Event end date and time * Event end date and time: Date * Event end date and time: Time * Critical range of time needed with EVP/CEO. * If the date requested cannot be met, please suggest alternative date. In-person or virtual? * - Select -In-PersonVirtual Event location Address * City * State/Province * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code * Location of event parking and arrangements/instructions for EVP/CEO? * Description of the event * Attire * Why do you want the EVP/CEO to attend? (If speaking, see additional questions below.) * Has the EVP/CEO attended this event before? * - Select -YesNoUnsure Run of Show Please attach file with run of show, invitation, agenda. * One file only.256 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Audience – Expected Guests (select all that apply) Donors and Friends Faculty Students Staff Trustees Elected Officials Community Members Alumni Other… Enter other… Are there any VIPs or dignitaries in the audience? * - Select -YesNo If yes, who? Are there notable University of Utah alumni in the audience? * - Select -YesNo If yes, who? Expected number of guests * Is the press/media expected to attend? * - Select -YesNo Will there be photos or video from the event? (select all that apply) Photos Video No photos/video If yes, which media organizations will be represented? Who is the contact for photos/footage with the EVP/CEO? (To be used for social media and other communication purposes.) Name Email Would you like the EVP/CEO to share remarks? * - Select -No remarks necessaryWelcoming remarks (3-5 minutes)Short remarks (5-10 minutes)Speech or presentation (15-20 minutes)Panel discussion Suggested topics, themes, talking points for remarks Will there be other speakers? - Select -YesNo If yes, who is speaking and in what order? Will there be discussion or Q&A with the audience? - Select -YesNo Audio/Visual Needs Please briefly describe available equipment (e.g. podium, sound system, projector/screen, etc.) Additional Notes or Comments Please include any additional notes or comments related to this appearance request. Leave this field blank
