Request for a County Commissioner to attend an event

2. Interested in having an Arapahoe County Commissioner speak at your event? Please use this form to request a Commissioner appearance. Please note that because of the large volume of requests and due to busy schedules, we cannot always guarantee that a Commissioner will be available. We will follow-up within three business days after receiving this form to discuss options.

   Interested in having an Arapahoe County Commissioner speak at your event? Please use this form to request a Commissioner appearance. Please note that because of the large volume of requests and due to busy schedules, we cannot always guarantee that a Commissioner will be available. We will follow-up within three business days after receiving this form to discuss options.

4. First Name*

5. Last Name*

6. Prefix*

   1. Mr.
   2. Mrs.
   3. Ms.

8. Email:*

9. Confirm Email:*

11. Phone Number:*

    Please include dashes

13. Is the requester the main point of contact?*

    1. yes
    2. no

15. If answer above is no, please fill out below

17. Contact First Name:

18. Contact Last Name:

20. Contact Email:

21. Contact Phone Number:

23. Name of group/organization:*

25. Purpose of group/organization:*

27. Event Name:*

28. Event Date and Time*
    Event Date and Time Start Date

    Event Date and Time Start Time

    —

    Event Date and Time End Date

    Event Date and Time End Time

    Date of event MUST be at least one week in advance with the understanding all requests might not be accommodated

29. Is this date fixed or is it flexible?*

    1. fixed
    2. flexible

31. Event Location:*

33. Address1*

35. Address2

37. City*

38. State*

39. Zip*

41. Event Description and Purpose:*

43. Event Attire*

    1. Business
    2. Business Casual
    3. Black Tie
    4. Informal
    5. Other

44. If other, please describe

45. Estimated number of people in attendance:*

47. Who would you like to attend:*

    1. Kathleen Conti, District 1
    2. Nancy N. Sharpe, District 2
    3. Jeff Baker, District 3
    4. Nancy Jackson, District 4
    5. Bill L. Holen, District 5

48. Will they need to speak at this event?*

    1. Keynote
    2. Brief Remarks
    3. Opening Remarks
    4. Closing Remarks
    5. Attendance Only
    6. Other

49. If other, please describe:

51. Desired length of time to make remarks:*

    1. 5 min.
    2. 10 min.
    3. 15 min.
    4. 30 min.
    5. Other

    If more than one Commissioner is requested to attend and speak, please use the other box to describe time needed per Commissioner

52. If other, please list amount of time

53. Speaking points or addition information please attach

55. Please attach and agenda and/or provide names/topics of other speakers

56. Do you anticipate media attendance or coverage?

    1. yes
    2. no

58. Notes or special instructions

Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field