Appearance Request

Please complete the following information to request the Governor to attend your event. All fields marked with an * are required and must be completed. Request subject to availability.

Event

*Date:	*Start Time:	*End Time:	*Number Attending:
*Group or Organization:

Contact Information

Name: * *

*Address:

*City: *State: *Zip:

*Email:

*Phone:

*Cell Phone:

*Fax:

Event Information:

*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?

Appearance:

*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: