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Event Request
Event Name
*
Event Date
*
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Event Description
Please be as specific as possible.
Event Start Time
*
Event End Time
*
Total Time Requested for Governor’s Participation (please list EXACT time frame)
Event Location
Location Name
*
Affiliated Organization(s)
*
Event Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Utah
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Virginia
Washington
West Virginia
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Event Location Phone Number
Is there On-site Security?
*
Yes
No
Name & Phone Number of Security Contact
Contact Information
First Name
*
Last Name
*
Organization
Position / Title
Primary Phone Number
*
Secondary Phone Number
Email Address
*
Your Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Additional Event Details
Would like the Governor to:
Attend
Feature/Keynote Speaker
Brief Remarks
Recognized Guest
Will there be any other keynote speakers? (if yes, please list their names)
Master of Ceremonies (name & title of person):
Who will introduce the Governor? (name & title of person):
Other Officials or Special Guests Confirmed to Attend
Number of Attendees
*
Event Attire (formal, cocktail, business, business casual, casual, etc.):
Open to Public?
*
Yes
No
Open to Media?
*
Yes
No
Who will greet the Governor? / Where?
*
List Names of All People Sitting at the Governor’s Table
Governor’s Holding Room Location (if needed)
If the Governor is unable to attend, would you be open to someone else from the Governor's office attending?
Yes
No
Is there anyone specific that you would like to request?
PLEASE attach a map of the room where the event will take place and denote where the Governor (and accompanying party) will be seated:
PLEASE attach an agenda for the event:
*
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