Faculty Speaker Program Request Form

To request a faculty speaker, fill out the form below and click "Submit."

If you would prefer to receive a hard copy of this form, please contact:

Director of Clubs, Alumnae Association
Tel: 781-283-2330
Fax: 781-283-3638
E-mail: wclubs@alum.wellesley.edu

Name of Club:
President/Program Chair Name:
College Last Name:
Class:
Address:
Telephone: (either home or work phone must be provided)	h: w:
E-mail Address:
Fax:
Preferred Time of Year:
Preferred Day of Week:
Preferred Time of Day:
Will this program include lunch or dinner? Yes No
Faculty: Please list names of speakers in order of preference Area of Interest: Preferred department and/or topic Administration: Preferred office and/or program