Speaking/Attendance Request Form

If you would like to request Mayor Smith to speak at or attend your meeting or event, please complete the request form below. Once your form has been submitted and reviewed, the City's Manager's Office will contact you about your request.

Please complete all fields and provide as much detail as possible. Thank you for your request.

* - Denotes required field

1. General Information:

Name *

Given

Family

Requesting Organization

2. Contact Information:

Daytime Phone

Extension

Email Address *

3. Type of Speaking Request:

Select Type

Keynote Speaker

Honoree

Guest

Other

Select Type Other

4. Press / Media

Is the press/media invited or involved:

Yes

5. Event Details:

Date *

Month

Day

Year

Time (from and to):

Location

Location Details

Who will be attending?

Is there anyone attending the event that the Mayor should recognize?

Please provide information about your organization, the event and any other important information. *

Please provide up to five examples of your organization's contributions to and involvement in the City of Winchester over the past two years. *

6. Speech Details:

Topic *

Length of Speech *

Who will introduce the Mayor? *

Who else is speaking/performing? *

What will be expected of the Mayor? *

Should the Mayor bring anything in particular? *

Can the Mayor bring a guest? *

Notification Email

Leave this field blank

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Speaking/Attendance Request Form