Graduation Speaker Confirmation Form
Please complete this form to confirm your participation as a speaker at the graduation ceremony and provide all required information.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Affiliation or Relationship to the Graduating Class
*
Will you be able to attend and deliver your speech at the graduation ceremony?
*
Yes, I confirm my attendance
No, I am unable to attend
Title or Topic of Your Speech
*
Estimated Duration of Speech (in minutes)
*
Please provide a brief biography (to be used in event materials)
*
Do you have any technical or audiovisual requirements for your speech?
Microphone
Projector/Screen
Laptop Connection
Other (please specify below)
If you selected 'Other' above, please specify your additional technical requirements here
Do you consent to your speech being recorded and/or broadcast as part of the graduation ceremony?
*
Yes, I consent
No, I do not consent
Please list any special instructions or requests for the event organizers
Signature (please sign to confirm your participation)
*
Submit Confirmation
Submit Confirmation
Should be Empty: