Request for Chancellor Event Appearance

Chancellor Sean Burrage, Oklahoma State Regents for Higher Education

"*" indicates required fields

To request that Chancellor Sean Burrage appear and/or speak at your event, please complete and submit this form. Call 405.225.9122 with questions.

Date of Event*

Time of Event*

Deadline for Notification of Chancellor's Availability*

Type of Event*

Purpose of Event*

Sponsoring Group or Organization*

Location of Event*

Address of Event*

Street Address Address Line 2 City State ZIP Code

Address Notes

Is This a Request for a Speech?*

Yes

Length of Speech

If Request for Other, Please Indicate Specifics

Size of Audience*

Media Involvement*

Who Will Provide the Introduction?*

Other Speakers or Performers Attending

Agenda

If you have an agenda, please upload it.

Accepted file types: docx, doc, pdf, txt, rtf, odt, pages, wpd, Max. file size: 5 MB.

Contact Person*

First Last

Contact Phone Number*

Contact Email*

Contact Fax*

Contact Address*

Street Address Address Line 2 City State ZIP Code

Contact Person at Event

(if different from above)

First Last

Contact Phone Number at Event

(if different from above)

Additional Comments/Information

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