Important scheduling information:

* Denotes required field

* Organization submitting request: 

Organization website: 

* Event title/name: 

* Event/Meeting description: 

Event location 

* Event location: 

Event/Meeting venue (if not the Governor's Mansion): 

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): 

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

* Is the date flexible? 

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

* Is this time flexible? 

Event details 

* How long should the Governor plan to speak? 

* Governor's role: 

* Has the Governor or past governors participated in the past? 

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

Will the media be invited? 

List the media that have been invited: 

* Will anyone introduce the Governor? 

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

Who else is speaking/performing? 

* Number of people attending: 

Will there be a microphone? 

Will there be a podium? 

Will there be a stage? 

Additional information: 

Contact information 
Primary contact 

* First name: 

* Last name: 

MI: 

* Email: 

* Phone: 

Address line 1: 

Address line 2: 

City: 

State: 

Zip: 

Cell phone: 

Additional contact 

First name: 

Last name: 

MI: 

Email: 

Phone: 

Address line 1: 

Address line 2: 

City: 

State: 

Zip: 

Cell phone: 

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