Scheduling Requests Event Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Time In * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Time Out * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm 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 *
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