Connect with the Chairman-Speaking Engagement 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 Title of Event Event Description Date of Event Is this date flexible? Yes No Time of Event 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 What time will the Chairman be speaking? Expected Duration of Event Event Location (Name or Venue) Venue Address Topic of Speech Requested DRA 101 & Agency Funding Programs General Economic Development Workforce Development Small Business & Entrepreneurship Health Access Other Other Requested Length of Speech/Address Anticipated Number of Attendees Description of General Audience Distinguished Guests to be in Audience Additional Information (if necessary) Is this event open to the public/media? No Yes Please list media invited/scheduled to attend. Please provide social media handles: Day of Event Contact Name Day of Event Contact Cell Attach a File if needed
