Event Name *

Street Address

Event Details:

Lt. Governor’s Role *
GuestSpeakerKeynote SpeakerHonoreeOther
If other, please describe

When is the event? *

Is the date flexible pending the Lt. Governor’s schedule?
Yes    No

If there is flexibility, please provide alternative dates and/or times:

Subject of Event (select all that apply):

Agriculture    Arts, Culture, History    Budget    Civil Rights    Education    Energy    Environmental    Government Issues    Jobs, Economic Development    Health    Homeland Security    International Trade    Labor    Public Safety    Social Issues    Taxes    Telecommunications    Tourism    Transportation    Other    NonProfit Fundraisers    Recognizing Employees
Event Subject Other

Location of Event

Participants / Audience

Are there other event partners/co-sponsors? If so, please list

Estimated number of attendees? *

Special guest or honoree?

Please describe the audience composition. What kinds of groups will be represented? *

Event Purpose

Please describe the objectives of the event. *

Does the event commemorate a special anniversary or an awareness day, week, or month?

Event Agenda

Please provide the agenda or rough outline of what will happen at the event. *

What do you want the Lt. Governor to know about your event and/or organization? (Please describe any announcements, achievements, unique elements, interesting photo opportunities, etc). *

Are you inviting the media? *
Yes    No

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