Mayor's Schedule Request

1. What is the event name?*

2. Who is the event sponsor?*

3. Where is the event location?*

4. What is the nature of the event?*

5. What date and time is the event taking place?*

6. What time is the event starting?*

7. What is the program time?*

8. What time is the event ending at?*

9. What is the estimated attendance?*

10. Is the Mayor being asked to speak at the event?*
    1. Yes
    2. No

11. Is the Mayor the keynote speaker?*
    1. Yes
    2. No

12. What is the length of time the Mayor will be requested to speak?*

13. Who will be introducing the Mayor?*

14. Is the event open to the public?*
    1. Yes
    2. No

15. Is the event open to the media?*
    1. Yes
    2. No

16. Who else will be speaking at this event?*

17. What type of event will this be? (Check all that apply)*
    1. Breakfast
    2. Lunch
    3. Dinner
    4. Meeting
    5. Reception
    6. Award Ceremony
    7. Press Conference
    8. Annual Event
    9. Rally
    10. Parade
    11. Fundraiser
    12. Conference
    13. Other
18. Other event type

19. Please describe the event?*

20. What will be the Mayor's role?*

21. Are there additional comments or details you would like to add?

22. Attach a flyer

23. Full Name*

24. Organization*

25. Address*

26. City*

27. State*

28. Zip Code*

29. What is your day time contact phone number?*

30. What is your evening contact phone number?*

31. What is your email address?*

Leave This Blank:


32. 1. Receive email copy
33. Email address

34. Submit

* indicates a required field