What is the name of your organization?

What is the name of your event?

What is the date? (mm/dd/yy)

Where will this event take place?

Facility name: Room Name or No.: Street (Physical) Address: City or Town:

Is this event indoors or outdoors?

Indoors Outdoors

Enter the time you would like the Lieutenant Governor to be on site: (hh:mm am/pm)

Enter the time you expect the Lieutenant Governor's role to end: ((hh:mm am/pm)

Main contact:

First Name
Last Name
Title
Organization
Contact Phone
E-mail

Person who will be meeting the Lieutenant Governor (If different than above):

Name
On-site (cell) phone

What is the anticipated role of the lieutenant governor at this event?

Keynote address
Speaking engagement (other than keynote)
Appearance (without formal speaking role)

If the Lieutenant Governor is to speak, about how long should the speech be? Please select:

A few informal remarks under two minutes Two to three minutes Three to five minutes Five to 10 minutes 10 to 15 minutes 15 to 20 minutes

About how many attendees will be at this event?

Between five and 25 Between 26 and 50 Between 51 and 100 Between 100 and 300 More than 300

Please describe the expected audience in any way possible (seniors, youth, professionals/occupation, ethnic affiliation, etc.) Why is this group together or what is its purpose?

What topics or issues (if any) might be of special
importance to this audience?

Is Mrs. (Linda) Owen invited?

Yes No No preference

Depending on the nature of the event, the Lieutenant Governor often asks that one (or more) members of his staff accompany him. Are there any limitations, concerns or special notes with regards to staff? Do you anticipate any security concerns?

Room layout (check any that apply):

 Conference   Theater   Meal Service   Lighting

Equipment availability (check all that apply):

Laptop Projector Screen  Mic Podium Riser

Who will introduce the Lt. Governor?

Name:

Title/Position with respect to organization:

Will there be a meal served while the lieutenant governor is at this event?

Yes, before speech Yes, concurrent with speech Yes, right after speech No meal

Will there be dignitaries in attendance whom Lt. Governor Owen should recognize? If so, please specify by name and title.

Are members of the news media invited/expected to be in attendance?

Yes No

Please either verify that there will there be a podium and microphone available for the Lieutenant Governor or describe why you feel one may not be necessary:

If this is a speech request, please "cut and paste" the program agenda or draft agenda in this box, or email separately to: ltgov@leg.wa.gov.

Additional information:

Questions? Please contact Tracy Chavez, the Lieutenant Governor's scheduler, at 360-786-7700 or by email at chavez.tracy@leg.wa.gov