Name:   (required)

Email:    (required)

Address:
Department:
Phone Number:

Title of Proposed Event:   


Event will be a:

Presentation/Speech 
Debate 
Panel Discussion 
Performance 
Other 

Description of the presentation, event, or activity:


The Athenaeum is usually held on Wednesdays at 1:00 p.m. Can you conduct your event at this time?

Yes
No, I prefer an alternative date and time

Proposed Day and Time:   

Anticipated Attendance
Number of People:     Type of Audience:

Equipment Needs:

Projector
Laptop
Internet
Sound
Musical Accompaniment


Biographical Information (degrees, faculty rank, length of time at APSU, research specialties, etc.):


Other Considerations or Information: