*Date:

*Start Time:

*End Time:

*Number Attending:

*Group or Organization:

Name: Mr. Ms. Mrs.  *     *

*Address:

*City: *State: *Zip:

*Email:

*Phone:

*Cell Phone:

*Fax:

*Event Name:

*Event Location:

*Address:

*City: *State: *Zip:

*Phone at Event Location:

*Fax at Event Location:

*Contact at Event:

*Contact Cell Phone:

*Is the event open to the public? Yes: No:

*Will a meal be served? Yes: No:

*If the Governor is not available, would another staff or cabinet representative be OK? Yes: No:

If yes, is there anyone in particular you would prefer?

*Type

Attend Only:

Keynote Speaker:

Welcome:

Brief Remarks:

Photo Op:

*What time would you like the Governor to arrive:  

*Exact Speaking Time: 

*Will there be a Q & A?   Yes: No:

*Other Speakers/Dignitaries:

*Who will introduce the Governor?

*Who will greet the Governor upon arrival?

*Attire:

*Media Contact:

Bio requested? Yes: No: (Available Online)

Photo Requested? Yes: No: (Available Online)

Additional Information: