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Meeting Request

Complete this form to request time with Shelley Berkley or other Touro administrators. Please note that your request should be made as far in advance as possible. It can take 2-4 weeks minimum to get scheduled.

Requested by:*
(i.e. individual name, title, organization name, department, etc.)
Type*
- Meeting
- Special Event
- Forum/Conference
- Fundraiser
- Reception
- Graduation
- Tour
- Speech/Featured Speaker
- Media interview
- Other
Location*
- Nevada campus
- California Campus
- off-campus, Nevada
- off-campus, California
- Other location
If off-campus, please provide address below.
Date of meeting*
Date Format: MM slash DD slash YYYY

Your requested date should be at least two weeks from the date you are submitting this form. If you have options on dates that you are available, please note the preferred date here and provide additional date options in the text field below.
Requested start time

: HH

MM
Requested start time

: HH

MM
Please indicate if meeting includes a meal*
Timeframe of required attendance
Please provide the time frame of required attendance. I.E.: if the event is eight hours, but you only need an attendee from 1:00 - 3:00, please note that here.
Requested attendee(s)*
Section Break
Contact Name for meeting*
Work phone*
(###)###-####
Cell Phone*
(###)###-####
Email*
Enter Email Confirm Email
Name of Organization or Company
Name of Meeting/event*
Sponsor(s) of event
Please provide complete address
Street Address City State ZIP Code
Purpose of meeting*
Please provide as many details as possible.
Format of meeting/event
Is there an agenda, program, etc?
Estimated number of people attending
Names of attendees
Column 1 Column 2

click the + box at the right to add up to a total of 20 names
Other speakers/VIP's
Column 1 Column 2

click the + box to the right to add up to a total of 20 names
Name
This field is for validation purposes and should be left unchanged.

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