Connect with the Chairman-Meeting Request Name Job Title Phone Cell: Email Organization Organization Street Address: City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Zip Code Website Meeting Subject Date of Meeting Is this date flexible? Yes No Time 7 a.m. 8 a.m. 9 a.m. 10 a.m. 11 a.m. 12 a.m. 1 p.m. 2 p.m. 3 p.m. 4 p.m. 5 p.m. 6 p.m. 7 p.m. Is this time flexible? Yes No Expected Duration Requesting Group or Individual/Requesting on behalf of Meeting Location (name of Venue) Meeting Venue address, city/state/zip, website (if applicable) Is this location flexible? Yes No Anticipated Number of Attendees List of Attendees Additional Information (if necessary) Is this event open to the public/media? No Yes Please list media invited/scheduled to attend. Day of Event Contact Name Day of Event Contact Cell Attach a File if needed
