Request Type:
AG Speaking Request
AG Event Attendance Only Request
AG Meeting Request
Event Information
Event Start Date/Time:
Event End Date/Time:
Requested AG Event Participation Time:
Exact Times Requested for AG to be at the Event
Event Name:
Type of Event:
Award Ceremony
Plenary Session/Keynote
Commencement
News Conference
Banquet
Other (specify in description)
Event Venue Details:
Please be as specific as possible
Event Street Address:
City:
State:
AK
AL
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP:
County:
Arkansas
Ashley
Baxter
Benton
Boone
Bradley
Calhoun
Carroll
Chicot
Clark
Clay
Cleburne
Cleveland
Columbia
Conway
Craighead
Crawford
Crittenden
Cross
Dallas
Desha
Drew
Faulkner
Franklin
Fulton
Garland
Grant
Greene
Hempstead
Hot Spring
Howard
Independence
Izard
Jackson
Jefferson
Johnson
Lafayette
Lawrence
Lee
Lincoln
Little River
Logan
Lonoke
Madison
Marion
Miller
Mississippi
Monroe
Montgomery
Nevada
Newton
Ouachita
Perry
Phillips
Pike
Poinsett
Polk
Pope
Prairie
Pulaski
Randolph
St. Francis
Saline
Scott
Searcy
Sebastian
Sevier
Sharp
Stone
Union
Van Buren
Washington
White
Woodruff
Yell
Event Location:
Indoors
Outdoors
Event Attire:
Formal
Business
Business Casual
Casual
Event Description:
Event Website/Social Media Address (if applicable):
Will Media be Invited/Present?
Yes
No
Expected Number of Attendees:
List Invited Groups:
Please Provide the Names/Titles of any Keynote Speakers (if applicable):
Please Provide the Names/Titles of those seated at the AG's Table (if applicable):
Speech Information:
Requested Speech Topic(s):
Request Speech Length:
Request Q&A Session:
Yes
No
Master of Ceremonies (Name/Title):
Who will introduce the AG (Name/Title)?
Will there a Podium?
Yes
No
What type of Microphone will be Available?
Wireless
Handheld
Podium Mic
No Microphone
Meeting Information:
Name/Title of Person(s) Requesting Meeting:
Reason for Meeting:
Meeting Location/Address:
Available Meeting Date(s)/Time(s):
Names/Titles of all Attendees:
Point of Contact Information:
Title:
First Name:
Last Name:
Organization:
Phone Number:
000-000-0000
Email:
Organization Website/Social Media Address (if applicable):
Additional Comments/Notes:
Submit