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Speaker Request Form

Dr. Eleanor Green
The Carl B. King Dean of Veterinary Medicine
College of Veterinary Medicine & Biomedical Sciences
Texas A&M University

We ask that speaker requests be submitted at least 2 weeks (if possible) before your event.

* denotes a required field.

Name of Event  *


Date/Time of Event*




Main Contact



Phone Number*


Email Address*


Alternate Contact


Phone Number

Email Address

Event Details

Description of Event*


Sponsoring Department/School/Organization

Type of Speech*                                                                                                   

PowerPoint Presentation* 

Goal/What does the audience want to hear?*


Equipment provided at the location*                   

Will there be other speakers?

If yes, what is the speaking order?

Who will be introducing Dr. Green?

Would you like to receive Dr. Green’s bio for the introduction?

Attendance Estimate*


Former Students or Donors in audience?

Dean’s expenses (if any) to be charged to