Location Information
Event Name:
*
Date/Time:
Select Time
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
*
Address:
*
City:
*
State / Zip:
AE
AP
AA
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
/
*
Phone:
*
Contact Information
Name:
*
Position:
Phone:
*
Email:
*
Event Information
Saxby's Role at the event:
Featured Speaker/Guest
Forum
Introduced and Brief Remarks
Recognized
Expected Number of Attendees:
Will the event be open to the public ?
Yes
No
Will media be attending the event?
Yes
No
Will the event be indoors or outdoors?
Indoors
Outdoors
Proper attire for the event:
Casual
Business
Black Tie
Event Specifics
Affiliated Organizations (if applicable):
Ticket Information (ticket price, who will the proceeds benefit, etc):
What is the purpose of the event?
What is the background of the event?
What is the proposed detailed time-line for the event?
Details about the group/audience that would be helpful to Saxby:
Please list the key issues that the organization would like Saxby to address:
Who will be speaking at the event? (names and titles)
Other officials or special guests expected to be in attendance: