Paul Simon Public Policy Institute Event Inquiry Form Please review and fill out the following questions. If you have questions about the form or our event process, please contact Associate Director, Carol Greenlee at cgreenlee@siu.edu or 618-453-4001. *Please note that event inquiries must be submitted at minimum 30 business days prior to the requested event date for consideration. OK Question Title * 1. Today's Date Date / Time Date OK Question Title * 2. What type of event are you inquiring about? New Event with the Institute New Event with Institute as only as a co-sponsor Speaking Request for Institute Director John Shaw Speaking Request for Visiting Professor Dr. John Jackson Speaking Request for Dr. Linda Baker Other (please specify) OK Question Title * 3. Proposed Event Date & Start Time: Date / Time Date Time AM/PM - AM PM OK Question Title * 4. Event Name: OK Question Title * 5. Event Location: OK Question Title * 6. Estimated Event Cost: OK Question Title * 7. Anticipated Head Count: OK Question Title * 8. Draft agenda or program outline available? Yes No OK Question Title * 9. If yes, please upload a copy: DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File If yes, please upload a copy: OK Question Title * 10. Please describe the event by including a program description, names of speakers and links to websites for verification. OK Question Title * 11. General Marketing Needs: OK Question Title * 12. General Catering Needs: OK Question Title * 13. General Media/Audio requirements? (i.e. microphones, PowerPoint, etc.) OK Question Title * 14. Contact Person Information: Name Title Company/Organization/Department/RSO Email Address Phone Number OK SUBMIT