Scheduling Request Please complete the form below to send a scheduling request to the Governor. Fields marked with an asterisk (*) are required. Note: filling out the request does not guarantee the Governor’s participation. Indicates required field Requestor Name Requestor Email Requestor Cell Number Requestor Office Number Type of Invitation/Request Meeting Event Meeting Form Requestor Company/Organization Meeting Date Meeting Purpose Meeting Attendees Are you willing to meet with staff if Governor is not available? Yes No Event Form Host Organization Event Name Event Summary Please provide a brief summary of the event Event Date Event Start Time Event End Time What is the Venue Name? Is the event indoors or outdoors? Indoor Outdoor Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code County - Select -AlamanceAlexanderAlleghanyAnsonAsheAveryBeaufortBertieBladenBrunswickBuncombeBurkeCabarrusCaldwellCamdenCarteretCaswellCatawbaChathamCherokeeChowanClayClevelandColumbusCravenCumberlandCurrituckDareDavidsonDavieDuplinDurhamEdgecombeForsythFranklinGastonGatesGrahamGranvilleGreeneGuilfordHalifaxHarnettHaywoodHendersonHertfordHokeHydeIredellJacksonJohnstonJonesLeeLenoirLincolnMaconMadisonMartinMcDowellMecklenburgMitchellMontgomeryMooreNashNew HanoverNorthamptonOnslowOrangePamlicoPasquotankPenderPerquimansPersonPittPolkRandolphRichmondRobesonRockinghamRowanRutherfordSampsonScotlandStanlyStokesSurrySwainTransylvaniaTyrrellUnionVanceWakeWarrenWashingtonWataugaWayneWilkesWilsonYadkinYancey Is the contact person at event the same as Requestor Yes No Type of Event Annual Meeting Conference Press Conference Tour Other type of event … Enter other… Estimated Number of Attendees Audience Description Dignitaries Attending Name Title Name Title Is event open to the public? Yes No Do you plan to invite media? Yes No Purpose of Governor’s Role What is Governor's level of participation? What is Governor's level of participation? - Select -SpeakAttendOther… Enter other… Time and Duration of Remarks Speaking Format Keynote Brief Remarks Roundtable Other speak format… Enter other… Who will introduce the Governor? List other speakers and order in which they will speak Name Title Topic Name Title Topic Are you willing to have staff or another member of the administration participate if Governor is unable to attend? Yes No Any additional information you wish to share Supporting material such as an invitation, program or biographies can be emailed to firstname.lastname@example.org. Please indicate the name and date of your event in the subject line.