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2. Requestor Name*
4. Requestor Address*
6. Address Line 2
8. City*
9. State*
10. Zip Code*
12. Phone Number*
13. Email Address*
17. Title Of Event*
19. Is this a new Business or Ribbon Cutting/Grand Opening?*

    1. Yes
    2. No
21. Brief Explanation Of the Event*
23. Date Of the Event*
    Date Of the Event
24. Start Time*
    Start Time
25. End Time*
    End Time
27. What time is the Mayor expected to arrive? Period of time you expect the Mayor to be in attendance.
31. Where is the Mayor specifically expected to be (Name and address of facility including room number/name/city)
33. Name Of the Facility*
35. Address Line 1*
37. Address Line 2
39. City*
40. State*
41. Zip Code*
43. Who is the contact person? Please provide their office number and/or cell number.
45. Name*
47. Phone Number*
48. Office Number
52. What will the Mayor's function be at this event?
54. Will the Mayor be expected to speak?*

    1. Yes
    2. No
56. If yes, on what topic and for how long? Are you requesting a speech or informal remarks? Will there be other speakers at this event? If so, please provide names & titles.
58. Will audio/visual equipment be available for Mayor presentation, i.e., computer, screen, projector, etc.?

    1. Yes
    2. No
60. Will pictures be taken of the Mayor?

    1. Yes
    2. No
61. If so, describe type of pictures.
63. Who is going to be in attendance and how many people are expected?
65. What type of attire is appropriate for this function?
67. Are spouses invited?

    1. Yes
    2. No
69. Please attach a proposed agenda/program for this event. All invitations, correspondence, and flyers using Mayor name must be approved before your organization can print or disseminate the information.
71. Date of request*
    Date of request

    (must be at least 10 working days in advance of when it is needed.)

73. Signature of Requestor*
Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit

* indicates a required field