Scheduling Requests

Event Date *

Month

Day

Year

Time In *

Hour

Minute

Time Out *

Hour

Minute

Name of the Event *

Primary Contact *

Primary Email Address *

Primary Phone Number for Day of Event *

Street Address, City, State, Zip *

Location/Room Number: *

Directions *

Lt. Governor's Role during event *

Number of People Expected *

Purpose of event *

Event Format *

Agenda *

Dress Code *

Names of Participants/Attendees: *

Other Participants:

Media Contacts *

1. The event host will contact the local media (list below).

2. The event host would like the Lt. Gov’s office to send a media advisory to local media.

3. The event host does not wish to have media coverage there (CLOSED EVENT)

4. The event host wishes to have media coverage there (OPEN EVENT)

Media List *