University Research Center
Event Information Form

Thank you for your interest. The following information is needed for scheduling purposes. Please return form to: University Research Center, Mississippi Institutions of Higher Learning, 3825 Ridgewood Road, Jackson, MS 39205 or fax to: 601-432-6117, phone: 601-432-6742, email:

Type of Request

For Speaking Engagements

Vita or Photo Requested


Please review the form carefully before submitting.