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Paul Simon Public Policy Institute Event Request Form
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Paul Simon Public Policy Institute Event Request
Please review and fill out the following form.
If you have any questions about the form or our event process, please contact the Institute at
paulsimoninstitute@siu.edu
.
*Please note that event inquiries must be submitted at minimum 30 business days prior to the requested event date for consideration.
First Name
Last Name
Display Name - Hidden
Email
Email Device Type - Hidden
Email Address
Evening Phone
Mobile Phone
Primary Phone
Email address for duplicate merging - Hidden
Phone
Phone Device Type - Hidden
Email Address
Evening Phone
Mobile Phone
Primary Phone
Company/Organization/Department/RSO
Title
What type of event are you inquiring about?
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
Event Date
Event Name
Is this event in person or virtual?
In Person
Virtual
Event Location
Estimated Event Cost
Anticipated Head Count
Do you have an agenda or program outline?
Yes
No
Please describe the event by including a program description, names of speakers and links to websites for verification.
General Marketing Needs
General Catering Needs
General Media/Audio Needs (i.e. Microphones, PowerPoint, etc.)
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