Secretary Speaking Request Form

Please provide the following information about your event or request. We will respond promptly. Thank you.
Event Name
Organization Name
Date of Event (What Day of the Week)
Location (Include Address)
Event Start Time
Speech Start Time
Event End Time
Contact Name
Contact E-Mail Address
Contact Phone
Contact Person Day of Event
Event Contact Phone/Cell preferred
What is the requested topic of discussion?
What is suggested speech length/time?
Will there be Q/A- if so, how much time?
Approx. size of audience
What is the audience demographic?
List any elected officials/notable attendees
Name/title of person introducing the Secretary
Will there be a Podium and Microphone?
Is there PowerPoint capability at this location?
Is the event open or closed to the media?
Provide parking and arrival instructions
Who will greet the Secretary on arrival?
More details/any other organizations involved
Alternate Speaker
Yes
No
(Please let us know if you would like an alternate DNR speaker, should the Secretary be unable to attend.)
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