Event Request Form

Date of Event (with day of the week):
Event Start Time:
Event End Time:
Mayor’s Participation Portion Start Time:
Mayor’s Participation Portion End Time:
Name of Event:
Sponsoring Organization:
Location of Event:
Street Address of Event (Include suite/room/floor number):
City:
State:
Zip Code:
Contact 1 Name and title:
Contact 1 Cell Phone Number with Area Code:
Contact 1 Alternate Phone Number with Area Code:
Contact 1 Email Address:
Contact 2 Name and title:
Contact 2 Cell Phone Number with Area Code:
Purpose of Event (Why are you asking the mayor to attend?):
Name of Person who will meet the mayor at the door?:
Cell Phone Number of Contact who will meet the mayor at the door:
Organization’s Most Recent Accomplishment/Proudest Point:
Other Background Information about your organization (website, mission statement, etc.):
Is the event space indoors or outdoors?:	Indoors Outdoors Other
Describe the space where the event will take place:
Where will the mayor's vehicle park?:
Are you requesting the mayor to speak at this event?:	YesNo
*Please indicate the type of remarks from the list below:	Select Value Welcoming Remarks (2-3 minutes) Brief Remarks (3-5 minutes) Keynote Speaker (5-7 minutes) Closing Remarks (2-3 minutes) News/Press Conference (2-3 minutes) Other
*Question & Answer Session?:	YesNo
*Who would you like to introduce the mayor?:
*Title of Person who would like to introduce the mayor:
*Approximate time during the program the mayor would speak:
*Topics you would like the mayor to address in his remarks:
*Recommended acknowledgments of organization leaders to include in the mayor's remarks:
*Will there be a microphone set up?:	YesNo
*Will there be a podium set up?:	YesNo
Approximate number of attendees:
Seating arrangements (Where will the mayor be seated and with whom?):
Describe the theme and atmosphere of this event:
Audience Composition (Organization Members, Students, National/Local Audience, etc.):
Suggested Attire:	Formal Business Business Casual Casual
Audience Attire:	Formal Business Business Casual Casual
What other elected officials/business leaders/community leaders/faith-based leaders are confirmed to attend?:
Is media invited to this event?:	YesNo
Is filming video permitted at this event?:	YesNo
Is photography permitted at this event?:	YesNo
Describe the event agenda/program/run of show or attach a file below (minute by minute agenda is required- you can email document instead of filling out this section):
Attachment 1:
Attachment 2:
Attachment 3:
Attachment 4:
Attachment 5:

Is correspondence (a letter or proclamation) from the Mayor needed for this event? If yes, please provide information for the correspondence here.