! 3. Model Application Form for an External Speaker 3.1 Section One [To be filled out by the student society/member of staff requesting permission for external speaker to appear on campus.] This must be filled out by a senior member of the society that wishes to invite an external speaker onto 15 working days campus. This form must be submitted a minimum of before the event is intended to take place. Organiser’s Details Name (including all names known by): Society/Club/ Department: Email: Phone: Event Details Event title: Event subject matter/themes: Proposed date: Proposed location: Name of event sponsor(s), if any: Will the audience be segregated by gender? [See Section 2.4 for requirements for this to be permitted] YES □ NO □ If YES, please state reason: Is this event being held as a debate where multiple and opposing ideas will be heard from the speakers on a panel? YES □ NO □ If YES, please list the speakers that will appear alongside this speaker: 13! !