Event Form

Please list the official name of the event and the group sponsoring the event:

Event date:

Event start time and the length of the event:

Event location and address (please list a specific street address):

Phone number at the event location:

Name of event contact or event host (please also list contact's title or affiliation with the event):

Please list the phone number of the event contact:

Please list the e-mail address of the event contact:

What time will Mary begin speaking and for how long will she speak?

On what topic and/or subject would you like Mary to speak?

Who will introduce Mary? (please list the person's title or position with the group if applicable)

Expected number of guests at the event?

Please list any local, state or county elected officials or other VIPs expected to attend the event:

Please list any other speakers at the event:

Whom will be seated with Mary (if applicable)?

What type of dress is expected for the event (business attire, formal, etc)?

Will there be a podium and/or microphone?