Appearance Request

* Event Date:

* Start Time:

* End Time:

* Number Attending:

* Group or Organization:

Name: Mr. Ms. Mrs.  *     *

* Address:

* City:   * State:   * Zip:

* Email:

* Phone:

* Cell Phone:

* Fax:

* Event Name:

* Event location:

   Room Name:

* Address:

* City: *State: *Zip:

* Phone at Event Location:

* Fax at Event Location:

* Contact for Event:

* Contact Cell Phone:

* Contact Email Address:

* Second Contact for Event:

* Second Contact Cell Phone:

* Second Contact Email Address:

* Is the event open to the public?   Yes: No:

* Is the event open to the media?   Yes: No:

* Will a meal be served?    Yes: No:

* If the Lt. Governor is not available, would another staff or cabinet representative be OK?   Yes: No:

If yes, is there anyone in particular you would prefer?

* Type
    Attend Only:
    Brief Remarks:

Keynote Speaker:
Photo Op:

Welcome:

* What time would you like the Lt. Governor to arrive?:  

* What time would you like the Lt. Governor to speak?:  

* Speech Length: 

* Speech Topic:     Comments: 

* Will there be a Q & A?   Yes: No:

* Does anyone speak before the Lt. Governor? Yes: No:
If yes, who?:

* Does anyone speak after the Lt. Governor? Yes: No:
If yes, who?:

* Other Speakers/Dignitaries:

* Who will introduce the Lt. Governor?: (include his/her title)

* Who will greet the Lt. Governor upon arrival?: (include his/her title)

* Appropriate Event Attire:

Bio requested?    Yes: No:
(Also available online at http://www.governor.ks.gov/LtGov/bio.htm)

Photo Requested?   Yes: No:
(Also available online at http://www.governor.ks.gov/LtGov/pressphoto.htm)

Additional Information: