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Events Request


For your event request to be considered, the following information must be submitted. Generally, a date cannot be confirmed until two weeks prior to the event.

* Required Fields


Event Name: *

Event Date: *
Event Time: *
* Please ensure your request is submitted 30 days prior to the event.

Physical Location of Event

Location Name: *

Address: *

Event City: *
Event State: *
Event Zip Code: *

Affiliated Organization(s): *

Authorized Contact Information
For scheduling purposes only.

Your First Name: *
Your Last Name: *

Organization:
Position/Title:

Work Phone Number: *
Cell Phone Number: *

Home Phone Number:
Email Address: *

Street Address: *

City: *
State: *
Zip Code: *

On-Site Contact

Your First Name: *
Your Last Name: *

Organization:
Position/Title:

Work Phone Number: *
Cell Phone Number: *

Home Phone Number: *
Email Address:

Street Address:

City:
State:
Zip Code:

Would you like the speaker to:


Other Officials or special guests who are confirmed to attend: *

Description of Event/Event Details (Please be as specific as possible): *

Number of Attendees?

Open to Public? *
Open to Media? *

Who would you like from the Secretary's office to attend? *
If Other, is there anyone specific that you would like to request?

Who will be attending this event? *

What topic would you like the speaker to cover? *

Would you like the speaker to:
Please describe very briefly the equipment available for the speaker's use.

Lectern/Podium available?
Microphone?
Computer / PowerPoint?
Attire?
Preferred time of arrival? *
Length of speaking time? *
Please provide AGENDA IF AVAILABLE
Q&A? *
Do you need a bio for the program?
Do you need a photo for the program?
Where will he be seated and with whom?
Is there a special reception before/after the event requested?
If so, is the speaker requested to attend?
Who will introduce him?
Will the speaker be asked to help give awards/recognition to any participants? If yes, please list the name of each award recipient and what/why they are receiving the award.
Where will he be seated and with whom?

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