Response

Organization submitting request:

Organization website:

Event title/name:

Event/Meeting description:

Event location

Event location:

Event/Meeting Venue (Preferred Video Conferencing Service if Virtual):

Street address:

Address line 2:

City:

State:

Zip:

On the following date and time

Event start date (mm/dd/yyyy):

Event end date (mm/dd/yyyy):

Event Start Time:

Event End Time:

Date Governor would attend (mm/dd/yyyy):

Is the date flexible? Yes
No

Time Governor would attend (hh:mm am/pm):

Is this time flexible? Yes
No

By what date must the governor's ability to attend be confirmed? (mm/dd/yyyy)

Event details

What do you want the governor to discuss?

How long should the Governor plan to speak?

Governor's role:

Has the Governor or past governors participated in the past? Yes
No

Who will be in attendance? (Include any special guests you have invited)

Will the media be invited? Yes
No

List the media that have been invited:

Will anyone introduce the Governor? Yes
No

Do you want time for questions? If so, please indicate how much time you'd like.

Length of Q&A

Who else is speaking/performing?

Number of people attending:

Will there be a microphone? Yes
No

Will there be a podium? Yes
No

Will there be a stage? Yes
No

Additional information:

Contact information

Primary contact

Prefix

Preferred Pronouns

First name:

Last name:

Email:

Phone:

Address line 1:

Address line 2:

City:

State:

Zip:

Cell phone:

Additional contact

Prefix

Preferred Pronouns

First name:

Last name:

Email:

Address line 2:

Address line 1:

State:

Zip:

City:

Cell phone:

Phone:

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