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):

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

* Is the date flexible? YesNo

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

* Is this time flexible? YesNo

Event details

* How long should the Governor plan to speak?

* Governor's role:

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

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

Will the media be invited? YesNo

List the media that have been invited:

* Will anyone introduce the Governor? YesNo

* 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? YesNo

Will there be a podium? YesNo

Will there be a stage? YesNo

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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